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Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study.
J Am Coll Cardiol 2010; 55(25):2825-32JACC

Abstract

OBJECTIVES

We investigated whether coronary microvascular dysfunction predicts major adverse outcomes during follow-up among women with signs and symptoms of ischemia.

BACKGROUND

Altered coronary reactivity occurs frequently in women evaluated for suspected ischemia, and the endothelium-dependent component is linked with adverse outcomes. Possible links between endothelium-independent microvascular coronary reactivity and adverse outcomes remain uncertain.

METHODS

As part of the National Heart, Lung and Blood Institute-sponsored WISE (Women's Ischemia Syndrome Evaluation), we investigated relationships between major adverse outcomes and baseline coronary flow reserve (CFR) after intracoronary adenosine in 189 women referred to evaluate suspected ischemia.

RESULTS

At a mean of 5.4 years, we observed significant associations between CFR and major adverse outcomes (death, nonfatal myocardial infarction, nonfatal stroke, or hospital stay for heart failure). An exploratory receiver-operator characteristic analysis identified CFR <2.32 as the best discriminating threshold for adverse outcomes (event rate 26.7%; and >or=2.32 event rate 12.2%; p = 0.01). Lower CFR was associated with increased risk for major adverse outcomes (hazard ratio: 1.16, 95% confidence interval: 1.04 to 1.30; p = 0.009). This held true among the 152 women without obstructive coronary artery disease (CAD) (hazard ratio: 1.20, 95% confidence interval: 1.05 to 1.38; p = 0.008). The CFR significantly improved prediction of adverse outcomes over angiographic CAD severity and other risk conditions.

CONCLUSIONS

Among women with suspected ischemia and atherosclerosis risk factors, coronary microvascular reactivity to adenosine significantly improves prediction of major adverse outcomes over angiographic CAD severity and CAD risk factors. These findings suggest that coronary microvessels represent novel targets for diagnostic and therapeutic strategies to predict and limit adverse outcomes in women. (Women's Ischemia Syndrome Evaluation [WISE]; NCT00000554).

Authors+Show Affiliations

Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida 32610-0277, USA. pepincj@medicine.ufl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Studies
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20579539

Citation

Pepine, Carl J., et al. "Coronary Microvascular Reactivity to Adenosine Predicts Adverse Outcome in Women Evaluated for Suspected Ischemia Results From the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) Study." Journal of the American College of Cardiology, vol. 55, no. 25, 2010, pp. 2825-32.
Pepine CJ, Anderson RD, Sharaf BL, et al. Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study. J Am Coll Cardiol. 2010;55(25):2825-32.
Pepine, C. J., Anderson, R. D., Sharaf, B. L., Reis, S. E., Smith, K. M., Handberg, E. M., ... Bairey Merz, C. N. (2010). Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study. Journal of the American College of Cardiology, 55(25), pp. 2825-32. doi:10.1016/j.jacc.2010.01.054.
Pepine CJ, et al. Coronary Microvascular Reactivity to Adenosine Predicts Adverse Outcome in Women Evaluated for Suspected Ischemia Results From the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) Study. J Am Coll Cardiol. 2010 Jun 22;55(25):2825-32. PubMed PMID: 20579539.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study. AU - Pepine,Carl J, AU - Anderson,R David, AU - Sharaf,Barry L, AU - Reis,Steven E, AU - Smith,Karen M, AU - Handberg,Eileen M, AU - Johnson,B Delia, AU - Sopko,George, AU - Bairey Merz,C Noel, PY - 2009/03/17/received PY - 2010/01/13/revised PY - 2010/01/18/accepted PY - 2010/6/29/entrez PY - 2010/6/29/pubmed PY - 2010/7/21/medline SP - 2825 EP - 32 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 55 IS - 25 N2 - OBJECTIVES: We investigated whether coronary microvascular dysfunction predicts major adverse outcomes during follow-up among women with signs and symptoms of ischemia. BACKGROUND: Altered coronary reactivity occurs frequently in women evaluated for suspected ischemia, and the endothelium-dependent component is linked with adverse outcomes. Possible links between endothelium-independent microvascular coronary reactivity and adverse outcomes remain uncertain. METHODS: As part of the National Heart, Lung and Blood Institute-sponsored WISE (Women's Ischemia Syndrome Evaluation), we investigated relationships between major adverse outcomes and baseline coronary flow reserve (CFR) after intracoronary adenosine in 189 women referred to evaluate suspected ischemia. RESULTS: At a mean of 5.4 years, we observed significant associations between CFR and major adverse outcomes (death, nonfatal myocardial infarction, nonfatal stroke, or hospital stay for heart failure). An exploratory receiver-operator characteristic analysis identified CFR <2.32 as the best discriminating threshold for adverse outcomes (event rate 26.7%; and >or=2.32 event rate 12.2%; p = 0.01). Lower CFR was associated with increased risk for major adverse outcomes (hazard ratio: 1.16, 95% confidence interval: 1.04 to 1.30; p = 0.009). This held true among the 152 women without obstructive coronary artery disease (CAD) (hazard ratio: 1.20, 95% confidence interval: 1.05 to 1.38; p = 0.008). The CFR significantly improved prediction of adverse outcomes over angiographic CAD severity and other risk conditions. CONCLUSIONS: Among women with suspected ischemia and atherosclerosis risk factors, coronary microvascular reactivity to adenosine significantly improves prediction of major adverse outcomes over angiographic CAD severity and CAD risk factors. These findings suggest that coronary microvessels represent novel targets for diagnostic and therapeutic strategies to predict and limit adverse outcomes in women. (Women's Ischemia Syndrome Evaluation [WISE]; NCT00000554). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/20579539/Coronary_microvascular_reactivity_to_adenosine_predicts_adverse_outcome_in_women_evaluated_for_suspected_ischemia_results_from_the_National_Heart_Lung_and_Blood_Institute_WISE__Women's_Ischemia_Syndrome_Evaluation__study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01437-3 DB - PRIME DP - Unbound Medicine ER -