Abstract 20443: Sex-Specific Coronary Vascular Function Thresholds and Prognosis: A Report From the Women’s Ischemia Syndrome Evaluation (WISE)
Background: Coronary flow reserve (CFR) of <2.5 predicts major adverse outcomes in predominantly male populations, while prior work demonstrates that CFR <2.32 is the best discriminating threshold for cardiovascular (CV) adverse outcomes in women with evidence of ischemia but no obstructive coronary artery disease (CAD). We evaluated whether the prognostic utility of coronary vascular function testing is improved by using gender specific thresholds during longer-term follow-up in the National Heart, Lung and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE).
Methods: Women (n=200) with signs and symptoms of ischemia and predominately non-obstructive CAD underwent coronary vascular function testing using intra-coronary adenosine, acetylcholine, and nitroglycerin (TNG). CV events defined as CV death, non-fatal MI, heart failure hospitalization or stroke were evaluated over a median follow-up of 6 years. Standard thresholds included CFR<2.5 to adenosine, coronary blood flow response (CBF) <50% to acetylcholine, TNG diameter response <20%. Optimal female sex-specific thresholds for prediction of CV events using ROC curves were constructed and compared to standard thresholds.
Results: Mean age was 56±10 years, 75% had no obstructive CAD, 27% diabetic, 61% hypertensive and 60% had hyperlipidemia. ROC analysis identified CFR <2.32, CBF<32% and TNG<7% as the best discriminating thresholds for female sex-specific CV event prediction. The female sex-specific abnormal thresholds of CFR improved CV event prediction, while trends were observed with CBF and TNG (Table).
Conclusion: Among women with signs and symptoms of ischemia and predominantly non-obstructive CAD, sex-specific abnormality thresholds for coronary vascular function testing may improve prognostication. Prospective investigation should address this hypothesis.
Author Disclosures: A. Al Badri: None. N. Bairey Merz: Research Grant; Significant; NIH/NHLBI, WISE HFpEF; Gilead (RWISE); FAMRI. Consultant/Advisory Board; Modest; Gilead, Medscape (paid to institution); NIH-CASE (grant review study section). Consultant/Advisory Board; Significant; Research Triangle Institute (RTI) International. B.D. Johnson: None. J. Wei: None. P.K. Mehta: None. S. Landes: None. Q. Li: None. S.E. Reis: None. S.F. Kelsey: None. V. Bittner: None. G. Sopko: None. C.J. Pepine: Research Grant; Significant; Capricor Inc. (ALLSTAR), inVentive (TEVA); Athersys; Vericel (ixCELL); NIH (CONCERT HF HL087318; CCTRN-2 HL087366; CTSI TR001427). B. Ahmed: None.
- © 2016 by American Heart Association, Inc.