{
  "abstract": "Introduction Angina with non-obstructive coronary arteries (ANOCA) is often managed conservatively with antianginal therapy. However, for unremitting ANOCA, the ESC guidelines give a class I recommendation to perform invasive coronary function testing (CFT) to identify the ANOCA endotype and instigate targeted therapy. 1 Appropriate case selection is required, given the risk of the procedure. Clinical decision making can be facilitated by understanding individual patient characteristics and whether these increase the pre-test probability of specific ANOCA endotype.Methods A retrospective analysis of electronic case records of 205 patients who underwent CFT at one NIHR-BHF CMD Workstream registered UK centre between June 2022 and December 2024 was performed. Compliance with ESC guidelines for ANOCA management at our centre, including the impact of testing on medical therapy prescription, was assessed. Pre-test patient characteristics (e.g. age, sex, cardiovascular risk factors, prior testing and number of presentations with chest pain) were analysed and compared between patients diagnosed with a specific ANOCA endotype (ANOCA+ve) vs not (ANOCA-ve).Results 138 (67.3%) patients had appropriate pre-CFT imaging and antianginal treatment. Testing for vasospastic angina (VSA) was performed in 115 (56.1%) patients, however VSA testing increased with time (2022 = 30%, 2023 = 43%, 2024 = 83%). 42 (67.7%) patients found to have endothelium-independent coronary microvascular dysfunction (e-iCMD) were prescribed ACE inhibitors, and 31 (93.9%) patients with isolated VSA were prescribed targeted therapy [ table 1]. 83 (75.5%) ANOCA-ve patients did not have their antianginal medications stopped, however 43 (51.8%) of these patients did not undergo VSA testing.There were no significant differences in cardiovascular risk factors [figure 1], sex, age, BMI, or pre-CFT imaging between ANOCA+ve and ANOCA-ve groups. However, ANOCA+ve patients had significantly more chest pain encounters prior to CFT than ANOCA-ve patients (p=0.024).Conclusion In our population, the number of prior healthcare encounters for chest pain positively correlated with a positive diagnosis of ANOCA, thus strengthening the argument of a need to undertake an invasive CFT in patients with recurrent chest pain presentations. However, neither patient characteristics, nor the number of invasive or non-invasive testing was predictive of a positive CFT test, which further underlines the ongoing challenges in patient selection for invasive testing.Improvements can be made in targeted therapy in e-iCMD patients, but also in stopping antianginal treatment in proven ANOCA-ve patients, to reduce medication burden and risk of drug interactions.Abstract 2-056 Table 1Percentage of patients treated according to recommendations in the 2024 ESC Guidelines for the management of chronic coronary syndromes1 CFT – coronary function testing, ANOCA – angina with non-obstructive coronary arteries, CMD – coronary microvascular dysfunction, VSA – vasospastic angina, ACE-I – Angiotensin converting enzyme inhibitorsAbstract 2-056 Figure 1Number of people who had different cardiovascular risk factors (hypertension, dyslipidaemia, diabetes, smoking history, or previous IHD) in the ANOCA+ve and ANOCA-ve groups. ANOCA – angina with non-obstructive coronary arteries, IHD – ischaemic heart diseaseReference Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45:3415–3537.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Bristol and Weston NHS Foundation Trust"
      ],
      "name": "H Withers"
    },
    {
      "affiliations": [
        "University Hospitals Bristol and Weston NHS Foundation Trust"
      ],
      "name": "J Abramik"
    },
    {
      "affiliations": [
        "University Hospitals Bristol and Weston NHS Foundation Trust"
      ],
      "name": "M Mariathas"
    }
  ],
  "title": "2-056 Can patient characteristics determine advanced need for invasive coronary function testing for angina with unobstructed arteries – a retrospective analysis",
  "uid": "85e5439e-b6b8-526e-934c-e742b2a2d74f"
}