Safety, Feasibility, and Diagnostic Yield of Invasive Coronary Function Testing: Netherlands Registry of Invasive Coronary Vasomotor Function Testing.

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology Pub Date : 2025-04-01 DOI:10.1001/jamacardio.2024.5670

Caïa Crooijmans, Tijn P J Jansen, Joan G Meeder, Janneke Woudstra, Martijn Meuwissen, Annemiek M J De Vos, Valeria Paradies, Els G M Olde Bijvank, Patty Winkler, Nicola S Vos, Karin Arkenbout, Pier Woudstra, Martin G Stoel, Tim P Van de Hoef, Stijn C H Van den Oord, Jos W M G Widdershoven, Wouter Remkes, Aysun Cetinyurek-Yavuz, Hester M Den Ruijter, N Charlotte Onland-Moret, Eric Boersma, Marcel A M Beijk, Yolande Appelman, Jan J Piek, Regina E Konst, Angela H E M Maas, Niels Van Royen, Aukelien C Dimitriu-Leen, Suzette E Elias-Smale, Peter Damman

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引用次数: 0

Abstract

Importance: Patients with angina and no obstructive coronary artery disease frequently have coronary vasomotor dysfunction as underlying pathophysiological mechanism, comprising epicardial spasm, microvascular spasm, and/or microcirculatory dysfunction. These endotypes can be diagnosed by invasive coronary function testing which has previously shown to be safe in tertiary and expert centers.

Objective: To determine the prevalence of vasomotor dysfunction in patients with angina and no obstructive coronary artery disease who were clinically referred for a coronary function test (CFT); and assess safety and feasibility of a CFT.

Design, setting, and participants: This quality improvement study was performed using the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL-CFT), a prospective, observational registry, in 15 participating hospitals (2 tertiary and 13 nontertiary). Patients with angina and no obstructive coronary artery disease who were referred for a clinically indicated CFT between December 2020 and January 2024 were included.

Main outcomes and measures: A complete CFT consisted of acetylcholine spasm provocation testing and assessment of microcirculatory function. Prevalence of different endotypes based on test results and overall safety were assessed.

Results: Among a total of 1207 patients included, 978 (81%) were female; and the mean (SD) age was 60 (10) years. The prevalence of coronary vasomotor dysfunction was very high (78%). There were 11 (0.9%) major and 10 (0.8%) minor complications reported. Of them, 3 major and all minor were definitely related to the coronary function test. No procedural death, myocardial infarction, or stroke was observed. No differences were found in the occurrence of complications between tertiary and nontertiary centers.

Conclusions and relevance: This study found that a CFT was feasible and safe to perform in both tertiary and nontertiary centers with a high diagnostic yield.

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有创冠状动脉功能检测的安全性、可行性和诊断率：荷兰有创冠状动脉血管舒缩功能检测登记处。

重要性：无阻塞性冠状动脉疾病的心绞痛患者常以冠状动脉血管舒张功能障碍为潜在的病理生理机制，包括心外膜痉挛、微血管痉挛和/或微循环功能障碍。这些内型可以通过侵入性冠状动脉功能检查诊断，这在三级和专家中心已经被证明是安全的。目的：探讨无阻塞性冠状动脉疾病的心绞痛患者行冠状动脉功能检查（CFT）时血管舒缩功能障碍的发生率；评估CFT的安全性和可行性。设计、环境和参与者：本质量改进研究采用荷兰有创冠状动脉血管舒张功能检测登记处（NL-CFT）进行，这是一项前瞻性、观察性登记处，在15家参与医院（2家三级医院和13家非三级医院）进行。纳入了在2020年12月至2024年1月期间转诊进行临床指征CFT的心绞痛患者和无阻塞性冠状动脉疾病患者。主要观察指标：完整的CFT包括乙酰胆碱痉挛激发试验和微循环功能评估。根据测试结果和总体安全性评估不同内型的患病率。结果：1207例患者中，女性978例（81%）；平均（SD）年龄60（10）岁。冠状动脉血管舒缩功能障碍的患病率非常高（78%）。主要并发症11例（0.9%），次要并发症10例（0.8%）。其中主要3例，次要3例均与冠状动脉功能检查有明确关系。没有观察到程序性死亡、心肌梗死或中风。三级中心和非三级中心的并发症发生率无差异。结论和相关性：本研究发现，在三级和非三级中心进行CFT是可行和安全的，诊断率高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine

CiteScore

45.80

自引率

1.70%

发文量

264

期刊介绍： JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.