Sex-differences in ANOCA patients undergoing invasive coronary function testing: preliminary results from the Dutch national NL-CFT registry
Authors: Woudstra J , Crooijmans C , Feenstra R G T , Jansen T P J , Vink C E M , Marques K M J , Chamuleau S A J , Dimitriu-Leen A L , Elias-Smale S E , Damman P , Beijk M A M , Appelman Y 
Published: October 2024

Abstract

Background
The majority of patients with angina and non-obstructive coronary arteries (ANOCA) are women. In most of these patients coronary vasomotor dysfunction, consisting of coronary vasospasm and coronary microvascular dysfunction (CMD), are identified through invasive coronary function testing (CFT). To acknowledge possible sex differences in clinical characteristics and in the entities of coronary vasomotor dysfunction more data are needed. Therefore, this study presents data from one centre participating in the Dutch national CFT (NL-CFT) registry in order to investigate sex differences in patients with a clinical indication for CFT.

Methods
This retrospective cohort study included 285 consecutive ANOCA patients undergoing clinically indicated CFT, using the Doppler wire or the bolus thermodilution method, from November 2016 till June 2023. CFT consisted of incremental doses of intracoronary acetylcholine (ACh) for the diagnosis of coronary vasospasm and intracoronary adenosine for the diagnosis of CMD defined as abnormal coronary flow reserve (CFR) and/or microvascular resistance (MR).

Results
In total, 285 patients of which 233 (82%) women and 52 (18%) men were included. Women were significantly younger (56 vs 59 yrs.; p=0.046), had less diabetes (6% vs 23% p&lt;0.001), less prior PCI (12% vs 27%; p=0.019) and less statin use (39% vs 60%; p=0.006), and more often migraine at some point in their life (38% vs 9%; p&lt;0.001). The prevalence of coronary vasomotor dysfunction (77% vs 65%, p=0.086), epicardial spasm (26% vs 31%, p=0.500), microvascular spasm (35% vs 23%, p=0.104), and CMD (35% vs 27%, p=0.304), was not significantly different between women and men. However, a trend was seen towards a higher prevalence of coronary vasomotor dysfunction, microvascular spasm and CMD in women. In total, 29% of women had an abnormal CFR compared to 16% of men (p=0.065) and an abnormal MR was seen in 11% of women and 12% of men (p=0.938). Cardiovascular risk factors were similar between women and men with epicardial spasm. In patients with microvascular spasm women had less prior PCI (p=0.025) and more migraine (p=0.005), in CMD patients women had less diabetes (p=0.002) and hypercholesterolemia (p=0.044) and more migraine (p=0.006).

Conclusion
In the NL-CFT registry study including ANOCA patients with a clinical indication for CFT women were younger, had less prior PCI and, diabetes and more often migraine. A trend towards a higher prevalence of coronary vasomotor dysfunction, microvascular spasm and CMD was found in women. Furthermore, our results suggest that men with CMD or microvascular spasm have a different cardiovascular risk profile compared to women, which might suggest different optimal tailored treatment for men compared to women.
* Upon acceptance for presentation at the ESC Congress, all patients from the Dutch NL-CFT registry will be incorporated into this analysis, resulting in a study population of approximately 1200 individuals.