https://doi.org/10.1007/s00392-025-02625-4
1Robert-Bosch-Krankenhaus Kardiologie und Angiologie Stuttgart, Deutschland
Background: Vascular aging contributes to structural and functional changes across various organs, including the heart. In patients with angina and no obstructive coronary artery disease (ANOCA/INOCA), coronary vasomotor disorders potentially causing angina pectoris may be attributed to coronary aging. However, the prevalence of these disorders across different age groups remains unclear.
Methods: We conducted coronary function testing (CFT) in 138 consecutive ANOCA/INOCA patients presenting with angina but without significant epicardial stenosis (<50%). The CFT included an intracoronary acetylcholine (ACh) coronary spasm test and an adenosine test to evaluate coronary microvascular dysfunction (CMD) by assessing coronary flow reserve (CFR) and hyperemic microvascular resistance (MR). We analyzed CFT outcomes in different age groups and between sexes. Categorical variables were compared using the Chi-square test, with statistical significance set at p < 0.05.
Results: Of the study cohort, 120 patients (87%) had a positive CFT result, with 109 (79%) exhibiting coronary spasm and 58 (42%) diagnosed with CMD (Table 1). There were no significant differences in the diagnostic yield of a positive CFT result across age groups (<55 years, 55–65 years, 66–75 years, >75 years) (p=0.9424), in the prevalence of coronary spasm (p=0.6361), or in CMD prevalence (p=0.5731). CMD subtypes also showed no significant age-related differences (CFR pathological/MR normal vs. CFR pathological/MR pathological vs. CFR normal/MR pathological; p=0.2824). Furthermore, no significant differences were observed in the distribution of CFT results between sexes across the age groups (p=0.4521).
Conclusion: Coronary vasomotor disorders are present across all age groups with similar prevalence rates, and no sex differences between age groups were observed. These findings suggest that vascular aging does not significantly impact the occurrence of coronary spasm or CMD. As such, these conditions should be considered in patients across all age groups, as various triggers or underlying causes may contribute to their manifestation.
Table 1: Diagnostic yield of coronary function testing in ANOCA/INOCA patients
|
ANOCA/INOCA patients N=138 |
<55 years old
N=44 (32%) |
55-65 years old
N= 31 (22%) |
66-75 years old
N= 39 (28%) |
>75 years old
N= 24 (17%) |
p-value |
|
Positive CFT results |
39 (89%) |
27 (87%) |
34 (87%) |
20 (83%) |
0.9424 |
|
- female |
23 |
17 |
26 |
13 |
0.4521 |
|
- male |
16 |
10 |
8 |
7 | |
|
Coronary spasm |
37 (84%) |
24 (77%) |
31 (79%) |
17 (71%) |
0.6361 |
|
- female |
21 |
14 |
24 |
11 |
0.3066 |
|
- male |
16 |
10 |
7 |
6 | |
|
CMD |
15 (34%) |
13 (42%) |
19 (49%) |
11 (46%) |
0.5731 |
|
- female |
11 |
9 |
15 |
9 |
0.8787 |
|
- male |
4 |
4 |
4 |
2 | |
|
- CFR path./MR normal |
11 (73%) |
8 (62%) |
16 (84%) |
6 (55%) |
0.2824 |
|
- CFR path./MR path. |
1 (7%) |
3 (23%) |
1 (5%) |
4 (36%) | |
|
- CFR normal/MR path. |
3 (20%) |
2 (15%) |
2 (11%) |
1 (9%) |