It has become apparent that coronary microvascular dysfunction (CMD), alone or in combination with coronary artery disease (CAD), is an adjunctive mechanism of myocardial ischemia and angina. However, this condition is rarely correctly diagnosed and, therefore, no tailored therapy is prescribed for these patients who are often dismissed as ¿false positive¿. These patients will continue to experience recurrent angina with poor quality of life, leading to repeated hospitalizations and unnecessary coronary angiography.
The objectives of this study are: 1) to investigate the prevalence of non-obstructive CAD in women vs men in an Italian population referred for ¿clinically indicated¿ coronary angiography; 2) to implement an ¿evidence based¿ therapy in these patients considering the underlying pathophysiological mechanism and evaluate the impact of a tailored therapy on angina.
Patients with angina but without obstructive CAD at angiography will be enrolled in 10 Italian centers. After completion of diagnostic coronary angiography, presence of coronary spasm (both epicardial and microvascular) will be investigated following intracoronary administration of acetylcholine. In case the latter test is negative,the index of microvascular resistance (IMR) and CFR will be assessed using a dedicated wire. According to the cath lab findings patients will be stratified into 2 groups :those with vs. without identified pathophysiological mechanism for their symptoms. A tailored medical therapy will be prescribed for the first group of patients according to the pathophysiologic mechanism involved. The patients will be then evaluated at one year clinical follow up in order to evaluate angina class, quality of life and occurrence of any coronary revascularization and cardiac hospitalization.
