Prognosis in women with myocardial ischemia in the absence of obstructive coronary disease: results from the National Institutes of Health-National Heart, Lung, and Blood Institute-Sponsored Women's Ischemia Syndrome Evaluation (WISE).
BACKGROUND
We previously reported that 20% of women with chest pain but without obstructive coronary artery disease (CAD) had stress-induced reduction in myocardial phosphocreatine-adenosine triphosphate ratio by phosphorus-31 nuclear magnetic resonance spectroscopy (abnormal MRS), consistent with myocardial ischemia. The prognostic implications of these findings are unknown.


RESULTS
Women referred for coronary angiography for suspected myocardial ischemia underwent MRS handgrip stress testing and follow-up evaluation. These included (1) n=60 with no CAD/normal MRS, (2) n=14 with no CAD/abnormal MRS, and (3) n=352 a reference group with CAD. Cardiovascular events were death, myocardial infarction, heart failure, stroke, other vascular events, and hospitalization for unstable angina. Cumulative freedom from events at 3 years was 87%, 57%, and 52% for women with no CAD/normal MRS, no CAD/abnormal MRS, and CAD, respectively (P<0.01). After adjusting for CAD and cardiac risk factors, a phosphocreatine-adenosine triphosphate ratio decrease of 1% increased the risk of a cardiovascular event by 4% (P=0.02). The higher event rate in women with no CAD/abnormal MRS was primarily due to hospitalization for unstable angina, which is associated with repeat catheterization and higher healthcare costs.


CONCLUSIONS
Among women without CAD, abnormal MRS consistent with myocardial ischemia predicted cardiovascular outcome, notably higher rates of anginal hospitalization, repeat catheterization, and greater treatment costs. Further evaluation into the underlying pathophysiology and possible treatment options for women with evidence of myocardial ischemia but without CAD is indicated.
Johnson
B Delia
BD
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa, USA.
Shaw
Leslee J
LJ
Buchthal
Steven D
SD
Bairey Merz
C Noel
CN
Kim
Hee-Won
HW
Scott
Katherine N
KN
Doyle
Mark
M
Olson
Marian B
MB
Pepine
Carl J
CJ
den Hollander
Jan
J
Sharaf
Barry
B
Rogers
William J
WJ
Mankad
Sunil
S
Forder
John R
JR
Kelsey
Sheryl F
SF
Pohost
Gerald M
GM
D000255:Adenosine Triphosphate / Q000032:analysis*; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D015331:Cohort Studies; D017023:Coronary Angiography; D023921:Coronary Stenosis; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D017048:Health Care Costs; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015993:Life Tables; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000191:economics / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D009206:Myocardium / Q000737:chemistry; D017063:Outcome Assessment, Health Care; D010725:Phosphocreatine / Q000032:analysis*; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D010725:Phosphocreatine; D000255:Adenosine Triphosphate