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Peer-reviewedCC BY-NC-ND 4.0JACC: Advances

ANOCA Patients With Prior Obstructive Coronary Artery Disease and PCI Have Higher Odds of Epicardial Spasm

  • Andreas Tzoumas1,2,3
  • Timothy D. Henry1,2,3
  • Anibelky Almanzar4
  • Sukhleen Kaur1,2
  • Ellen Cravero5
  • Namrita Ashokprabhu1,2
  • Somesh Rai1,2
  • Jane Carnesi1,2
  • Claire Hanycz1,2
  • Jenny Zhang1,2
  • Elnaz Mahbub1,2
  • Evan Lakhia1,2
9 more authors
  • Jacob T. Davis1,2
  • Ayushi Mohan1,2
  • Kamryn Wilson1,2
  • Audrey Baker1,2
  • Philip Forrest1,2
  • Kaiya Hansen1,2
  • Michelle Hamstra1,2
  • Danielle N. Tapp1,2
  • Odayme Quesada1,2,3
5 affiliations
  1. 1Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
  2. 2The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
  3. 3Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, Ohio
  4. 4Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
  5. 5Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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Abstract

Background: Up to 50% of patients undergoing coronary angiography have angina with no obstructive coronary arteries (ANOCA). Among ANOCA patients, 2 distinct groups exist: patients with and without a history of prior obstructive coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI).

Objectives: This study aims to evaluate associations between history of prior obstructive CAD treated with PCI and coronary microvascular and vasomotor dysfunction endotypes in ANOCA patients.

Methods: A prospective Coronary Microvascular and Vasomotor Dysfunction Registry of consecutive ANOCA patients undergoing invasive coronary functional testing (ICFT).

Results: Among 624 ANOCA patients undergoing ICFT, 11% had prior obstructive CAD treated with PCI. ANOCA patients with prior obstructive CAD had a higher prevalence of males, were older, and had higher rates of cardiovascular risk factors. Prior obstructive CAD treated with PCI was associated with an 11-point lower Seattle Angina Questionnaire 7 summary score in unadjusted (β −11.0; 95% CI: −17.0 to −4.4; P = 0.001) and adjusted models. Patients with prior obstructive CAD treated with PCI had a higher prevalence of epicardial spasm by angiographic criteria (70% vs 34%; P < 0.001) and 4.55-fold higher odds of epicardial spasm in unadjusted (OR: 4.55; 95% CI: 2.65-8.07; P < 0.001) and adjusted models, with similar odds of coronary microvascular dysfunction.

Conclusions: Among ANOCA patients, those with prior obstructive CAD treated with PCI had over a 4-fold higher odds of epicardial spasm. These findings underscore the need for comprehensive ICFT in ANOCA patients with prior PCI.

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Cite

BibTeXRIS
BibTeX
@article{tzoumas2026anoca,
  title = {{ANOCA Patients With Prior Obstructive Coronary Artery Disease and PCI Have Higher Odds of Epicardial Spasm}},
  author = {Andreas Tzoumas and Timothy D. Henry and Anibelky Almanzar and Sukhleen Kaur and Ellen Cravero and Namrita Ashokprabhu and Somesh Rai and Jane Carnesi and Claire Hanycz and Jenny Zhang and Elnaz Mahbub and Evan Lakhia and Jacob T. Davis and Ayushi Mohan and Kamryn Wilson and Audrey Baker and Philip Forrest and Kaiya Hansen and Michelle Hamstra and Danielle N. Tapp and Odayme Quesada},
  journal = {JACC: Advances},
  year = {2026},
  month = sep,
  doi = {10.1016/j.jacadv.2026.103319},
  url = {https://doi.org/10.1016/j.jacadv.2026.103319},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - ANOCA Patients With Prior Obstructive Coronary Artery Disease and PCI Have Higher Odds of Epicardial Spasm
AU  - Andreas Tzoumas
AU  - Timothy D. Henry
AU  - Anibelky Almanzar
AU  - Sukhleen Kaur
AU  - Ellen Cravero
AU  - Namrita Ashokprabhu
AU  - Somesh Rai
AU  - Jane Carnesi
AU  - Claire Hanycz
AU  - Jenny Zhang
AU  - Elnaz Mahbub
AU  - Evan Lakhia
AU  - Jacob T. Davis
AU  - Ayushi Mohan
AU  - Kamryn Wilson
AU  - Audrey Baker
AU  - Philip Forrest
AU  - Kaiya Hansen
AU  - Michelle Hamstra
AU  - Danielle N. Tapp
AU  - Odayme Quesada
PY  - 2026
DA  - 2026/09/22
JO  - JACC: Advances
DO  - 10.1016/j.jacadv.2026.103319
UR  - https://doi.org/10.1016/j.jacadv.2026.103319
AB  - Background: Up to 50% of patients undergoing coronary angiography have angina with no obstructive coronary arteries (ANOCA). Among ANOCA patients, 2 distinct groups exist: patients with and without a history of prior obstructive coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI).  Objectives: This study aims to evaluate associations between history of prior obstructive CAD treated with PCI and coronary microvascular and vasomotor dysfunction endotypes in ANOCA patients.  Methods: A prospective Coronary Microvascular and Vasomotor Dysfunction Registry of consecutive ANOCA patients undergoing invasive coronary functional testing (ICFT).  Results: Among 624 ANOCA patients undergoing ICFT, 11% had prior obstructive CAD treated with PCI. ANOCA patients with prior obstructive CAD had a higher prevalence of males, were older, and had higher rates of cardiovascular risk factors. Prior obstructive CAD treated with PCI was associated with an 11-point lower Seattle Angina Questionnaire 7 summary score in unadjusted (β −11.0; 95% CI: −17.0 to −4.4; P = 0.001) and adjusted models. Patients with prior obstructive CAD treated with PCI had a higher prevalence of epicardial spasm by angiographic criteria (70% vs 34%; P < 0.001) and 4.55-fold higher odds of epicardial spasm in unadjusted (OR: 4.55; 95% CI: 2.65-8.07; P < 0.001) and adjusted models, with similar odds of coronary microvascular dysfunction.  Conclusions: Among ANOCA patients, those with prior obstructive CAD treated with PCI had over a 4-fold higher odds of epicardial spasm. These findings underscore the need for comprehensive ICFT in ANOCA patients with prior PCI.
SN  - 2772-963X
ER  -