■大约30%至50%的被转诊为诊断性冠状动脉造影的患者没有阻塞性冠状动脉疾病(CAD)。缺血和非梗阻性冠状动脉(INOCA)越来越被认可,包括冠状动脉微血管功能障碍,血管痉挛型心绞痛,有症状的心肌桥,和其他血管舒缩障碍。然而,这些疾病的患病率以及潜在的动脉粥样硬化斑块负荷和形态是否影响每种生理表型的长期结局尚不清楚.
DISCOVERINOCA注册正在美国的8个中心进行,并计划招募500名缺血性心脏病患者接受冠状动脉功能检查(CFT)的血管造影术。所有参与者将完成患者报告的结果测量,并接受协议引导的血管造影,乙酰胆碱激发,冠状动脉热稀释,和血管内成像。随访评估发生在30天,6个月,1年,每年5年。主要短期终点是基于生理学的INOCA表型的患病率和基于血管内超声或光学相干断层扫描(血管内成像)的动脉粥样硬化程度。主要的长期终点是主要不良心血管事件的发生率,定义为心血管死亡的复合物,心肌梗塞,因心血管原因住院,或冠状动脉血运重建在5年的随访。在此发布时,已有100名参与者参加。
■DISCOVERINOCA是首例针对INOCA患者的前瞻性研究,旨在整合疾病的解剖和生理指标,并将其与长期结局相关联。发现INOCA将报告INOCA表型的患病率,全面侵入性CFT的安全性,以及测试对诊断和药物治疗的影响。长期随访的症状和心血管不良事件将在接受血管造影的无阻塞性CAD患者中确定。
UNASSIGNED: Approximately 30% to 50% of patients who are referred for diagnostic coronary angiography are found to have no obstructive coronary artery disease (CAD). Ischemia and nonobstructive coronary arteries (INOCA) is increasingly recognized and encompasses coronary microvascular dysfunction, vasospastic angina, symptomatic myocardial bridging, and other vasomotor disorders. However, the prevalence of these disorders and whether underlying atherosclerotic plaque burden and morphology affect the long-term outcomes of each physiologic phenotype is unknown.
UNASSIGNED: The DISCOVER INOCA registry is ongoing at 8 centers in the United States and plans to enroll 500 patients with ischemic heart disease referred for angiography undergoing coronary function testing (CFT). All participants will complete patient-reported outcome measures and undergo protocol-guided angiography, acetylcholine provocation, coronary thermodilution, and intravascular imaging. Follow-up assessments occur at 30 days, 6 months, 1 year, and annually for 5 years. The primary short-term end point is the prevalence of INOCA phenotypes based on physiology and the degree of atherosclerosis based on intravascular ultrasound or optical coherence tomography (intravascular imaging). The primary long-term end point is the incidence of major adverse cardiovascular events, defined as a composite of cardiovascular death, myocardial infarction, hospitalization for cardiovascular causes, or coronary revascularization at a follow-up of 5 years. At the time of this publication, 100 participants have been enrolled.
UNASSIGNED: DISCOVER INOCA is the first prospective study of INOCA patients to integrate anatomic and physiologic measures of disease and correlate them with long-term outcomes. DISCOVER INOCA will report on the prevalence of INOCA phenotypes, the safety of comprehensive invasive CFT, and the impact of testing on diagnoses and medical therapy. Symptoms and cardiovascular adverse events at long-term follow-up will be determined in patients with no obstructive CAD undergoing angiography.