Invasive Coronary Function Testing Safe and Effective for Diagnosing Vasomotor Dysfunction in ANOCA Patients: Study

Notably, the study also found that invasive coronary functional testing to identify the cause of angina in patients with nonobstructive coronary artery disease (ANOCA) can be safely performed at highly experienced and less-experienced centers, further supporting its broader clinical applicability.

"The invasive testing was conducted across 15 tertiary and nontertiary hospitals in the Netherlands, yielding a high diagnostic success rate. Spasm emerged as the most common ANOCA endotype, while the procedure was associated with low rates of both major and minor complications," the researchers reported.

The researchers note that patients with angina and no obstructive coronary artery disease often have coronary vasomotor dysfunction, including epicardial spasm, microvascular spasm, and microcirculatory dysfunction. Invasive coronary function testing effectively diagnoses these endotypes and has previously been deemed safe in expert tertiary centers. Considering this, Caïa Crooijmans, Department of Cardiology Radboudumc, Nijmegen, the Netherlands, and colleagues aimed to assess the prevalence of vasomotor dysfunction in clinically referred ANOCA patients while evaluating the safety and feasibility of coronary function testing.

For this purpose, the researchers conducted a quality improvement study using the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL-CFT), a prospective observational registry involving 15 hospitals, including two tertiary and 13 nontertiary centers. The study included patients with angina and no obstructive coronary artery disease who were referred for a clinically indicated coronary function test (CFT) between December 2020 and January 2024. A complete CFT comprised of acetylcholine spasm provocation testing and the assessment of microcirculatory function. The study evaluated the prevalence of different endotypes based on test results while also assessing the overall safety of the procedure.

The investigation uncovered the following findings:

• 1,207 patients were included, with 978 (81%) females. The mean age of participants was 60 years.
• Coronary vasomotor dysfunction was highly prevalent, affecting 78% of patients.
• Major complications were reported in 11 cases (0.9%), while minor complications occurred in 10 of the cases (0.8%).
• Among these, three major and all minor complications were directly related to the coronary function test.
• No cases of procedural death, myocardial infarction, or stroke were observed.
• The occurrence of complications was similar between tertiary and nontertiary centers.

The researchers found coronary function testing is feasible and safe across tertiary and nontertiary centers, demonstrating a high diagnostic yield. Their findings suggest considering CFT for all patients with angina and no obstructive coronary artery disease, given its effectiveness in identifying vasomotor dysfunction, which was present in 78% of cases.

"Conducted within the Dutch NL-CFT network, the study reported a very low overall complication rate of 1.7%, reinforcing the procedure’s safety. With no observed cases of procedural death, myocardial infarction, or stroke, and comparable complication rates across different healthcare settings, the results support broader clinical adoption of CFT for improved diagnosis and management of coronary vasomotor dysfunction," the researchers wrote.

Reference:

Crooijmans C, Jansen TPJ, Meeder JG, et al. Safety, Feasibility, and Diagnostic Yield of Invasive Coronary Function Testing: Netherlands Registry of Invasive Coronary Vasomotor Function Testing. JAMA Cardiol. Published online February 19, 2025. doi:10.1001/jamacardio.2024.5670