BACKGROUND Determine the prevalence and correlates of microvascular and vasospastic angina in patients with symptoms and signs of ischemia but no obstructive coronary artery disease (INOCA). METHODS Three hundred ninety-one patients with angina were enrolled at 2 regional centers over 12 months from November 2016 (NCT03193294). INOCA subjects (n=185; 47%) had more limiting dyspnea (New York Heart Association classification III/IV 54% versus 37%; odds ratio [OR], 2.0 [1.3-3.0]; P=0.001) and were more likely to be female (68% INOCA versus 38% in coronary artery disease; OR, 1.9 [1.5 to 2.5]; P<0.001) but with lower cardiovascular risk scores (ASSIGN score median 20% versus 24%; P=0.003). INOCA subjects had similar burden of angina (Seattle Angina Questionnaire) but reduced quality of life compared with coronary artery disease; subjects (EQ5D-5 L index 0.60 versus 0.65 units; P=0.041). RESULTS An interventional diagnostic procedure with reference invasive tests including coronary flow reserve, microvascular resistance, and vasomotor responses to intracoronary acetylcholine (vasospasm provocation) was performed in 151 INOCA subjects. Overall, 78 (52%) had isolated microvascular angina, 25 (17%) had isolated vasospastic angina, 31 (20%) had both, and 17 (11%) had noncardiac chest pain. Regression analysis showed inducible ischemia on treadmill testing (OR, 7.5 [95% CI, 1.7-33.0]; P=0.008) and typical angina (OR, 2.7 [1.1-6.6]; P=0.032) were independently associated with microvascular angina. Female sex tended to associate with a diagnosis of microvascular angina although this was not significant (OR, 2.7 [0.9-7.9]; P=0.063). Vasospastic angina was associated with smoking (OR, 9.5 [2.8-32.7]; P<0.001) and age (OR, 1.1 per year, [1.0-1.2]; P=0.032]. CONCLUSIONS Over three quarters of patients with INOCA have identifiable disorders of coronary vasomotion including microvascular and vasospastic angina. These patients have comparable angina burden but reduced quality of life compared to patients with obstructive coronary artery disease. Microvascular angina and vasospastic angina are distinct disorders that may coexist but differ in associated clinical characteristics, symptoms, and angina severity. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03193294.

中文翻译：

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缺血和非阻塞性冠状动脉疾病：冠状动脉血管舒缩障碍的患病率和相关性。

背景 确定有缺血症状和体征但无阻塞性冠状动脉疾病 (INOCA) 的患者中微血管和血管痉挛性心绞痛的患病率和相关性。方法 自 2016 年 11 月起的 12 个月内，在 2 个区域中心入组了 391 名心绞痛患者 (NCT03193294)。INOCA 受试者 (n=185；47%) 有更多限制性呼吸困难（纽约心脏协会分类 III/IV 54% 对比 37%；比值比 [OR]，2.0 [1.3-3.0]；P=0.001），并且更有可能女性（冠状动脉疾病为 68% INOCA 对比 38%；OR，1.9 [1.5 至 2.5]；P<0.001），但心血管风险评分较低（ASSIGN 评分中位数为 20% 对比 24%；P=0.003）。INOCA 受试者的心绞痛负担相似（西雅图心绞痛问卷），但与冠状动脉疾病相比，生活质量降低；受试者（EQ5D-5 L 指数 0.60 与 0.65 单位；P=0.041）。结果 对 151 名 INOCA 受试者进行了介入诊断程序，其中包括冠状动脉血流储备、微血管阻力和对冠状动脉内乙酰胆碱（血管痉挛激发）的血管舒缩反应等参考侵入性测试。总体而言，78 例 (52%) 患有单纯性微血管性心绞痛，25 例 (17%) 患有单纯性血管痉挛性心绞痛，31 例 (20%) 两者兼有，17 例 (11%) 患有非心源性胸痛。回归分析显示跑步机测试诱导缺血（OR，7.5 [95% CI，1.7-33.0]；P=0.008）和典型心绞痛（OR，2.7 [1.1-6.6]；P=0.032）与微血管心绞痛独立相关。女性往往与微血管性心绞痛的诊断相关，尽管这并不显着（OR，2.7 [0.9-7.9]；P=0.063）。血管痉挛性心绞痛与吸烟 (OR, 9.5 [2.8-32.7]; P<0.001) 和年龄 (OR, 每年 1.1, [1.0-1.2]; P=0.032] 有关。结论 超过四分之三的 INOCA 患者患有可识别的血管痉挛性心绞痛。冠状动脉血管舒缩障碍，包括微血管性心绞痛和血管痉挛性心绞痛。与阻塞性冠状动脉疾病患者相比，这些患者的心绞痛负担相当，但生活质量降低。微血管性心绞痛和血管痉挛性心绞痛是可能共存的不同疾病，但在相关的临床特征、症状、和心绞痛严重程度。临床试验注册网址：https://www.clinicaltrials.gov。唯一标识符：NCT03193294。