PericOronary INflammaTion in Non-Obstructive Coronary Artery Disease (POINT-NOCAD)

NYU Langone Health

Status: Terminated

Conditions: Non-Obstructive Coronary Atherosclerosis

Treatments: Drug: Metoprolol; Drug: Isovue; Procedure: Coronary computed tomography angiography (CCTA); Drug: Nitroglycerin

Study type: Observational

Funder types: Other

Identifiers

NCT05031520

21-00764

Details and patient eligibility

About

Among patients with ischemic heart disease who are referred for coronary angiography, a substantial proportion have non-obstructive coronary artery disease (CAD). Myocardial infarction (MI) with non-obstructive coronary artery disease (MINOCA) accounts for 5-20% of patients with MI and preferentially affects women. MINOCA pathogenesis is varied and may include atherosclerotic plaque rupture, plaque erosion with thrombosis, vasospasm, embolization, dissection or a combination of mechanisms. Other patients may have clinically unrecognized myocarditis, or takotsubo syndrome masquerading as MI. Among patients referred for coronary angiography for the evaluation of stable ischemic heart disease, non-obstructive CAD is present in up to ~30% of men and ~60% of women. Stable ischemia with non-obstructive coronary arteries (INOCA) may be due to coronary microvascular dysfunction in up to 40% of these patients. Our understanding of mechanisms of MINOCA and INOCA remain incomplete. Coronary inflammation has been hypothesized as a potential mechanism contributing to coronary spasm in MINOCA and microvascular disease in INOCA.

Full description

The PericOronary INflammaTion in Non-Obstructive Coronary Artery Disease (POINT-NOCAD) study is a single-center diagnostic, observational study enrolling men and women with MINOCA or INOCA who are planned to undergo (or underwent) clinically indicated coronary angiography. The research plan is to evaluate coronary inflammation, as measured by the perivascular coronary fat attenuation index from non-invasive coronary computed tomography angiography (CCTA), in patients with MINOCA and INOCA.

Enrollment: 32 patients

Sex: All

Ages: 18 to 125 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult age ≥18 years referred for clinically indicated coronary angiography
• Stable ischemic heart disease OR acute myocardial infarction as the indication for coronary angiography

Exclusion criteria

Clinical Exclusion criteria:

• Estimated glomerular filtration rate < 45 mL/min
• History of allergic reaction to iodinated contrast media
• Pregnancy

Angiographic / Post-Cath Exclusion criteria:

• Obstructive CAD (≥50% luminal obstruction in ≥1 major epicardial coronary arteries by invasive coronary angiography)
• Allergic reaction to iodinated contrast media

Trial design

32 participants in 1 patient group

Intervention group

Description:

Participants will be identified by review of the cardiac catheterization laboratory schedule each day by the principal investigator, a co-investigator, or a research coordinator. Participants with no obstructive CAD and completed microvascular testing will undergo a research CCTA.

Treatment:

Drug: Nitroglycerin

Procedure: Coronary computed tomography angiography (CCTA)

Drug: Isovue

Drug: Metoprolol