{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:19:35Z","timestamp":1791883175287,"version":"4.3.4"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,5,3]]},"abstract":"\n Background<\/jats:title>\n In the absence of obstructive coronary stenoses, abnormality of noninvasive stress tests (NIT) in patients with chronic coronary syndromes may indicate myocardial ischemia of nonobstructive coronary arteries (INOCA). The differential prognosis of INOCA according to the presence of coronary microvascular dysfunction (CMD) and incremental prognostic value of CMD with intracoronary physiologic assessment on top of NIT information remains unknown.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n From the international multicenter registry of intracoronary physiologic assessment (ILIAS [Inclusive Invasive Physiological Assessment in Angina Syndromes] registry, N=2322), stable patients with NIT and nonobstructive coronary stenoses with fractional flow reserve >0.80 were selected. INOCA was diagnosed when patients showed positive NIT results. CMD was defined as coronary flow reserve \u22642.5. According to the presence of INOCA and CMD, patients were classified into 4 groups: group 1 (no INOCA nor CMD, n=116); group 2 (only CMD, n=90); group 3 (only INOCA, n=41); and group 4 (both INOCA and CMD, n=40). The primary outcome was major adverse cardiovascular events, a composite of all\u2010cause death, target vessel myocardial infarction, or clinically driven target vessel revascularization at 5\u00a0years. Among 287 patients with nonobstructive coronary stenoses (fractional flow reserve=0.91\u00b10.06), 81 patients (38.2%) were diagnosed with INOCA based on positive NIT. By intracoronary physiologic assessment, 130 patients (45.3%) had CMD. Regardless of the presence of INOCA, patients with CMD showed a significantly lower coronary flow reserve and higher hyperemic microvascular resistance compared with patients without CMD (\n P<\/jats:italic>\n <0.001 for all). The cumulative incidence of major adverse cardiovascular events at 5\u00a0years were 7.4%, 21.3%, 7.7%, and 34.4% in groups 1 to 4. By documenting CMD (groups 2 and 4), intracoronary physiologic assessment identified patients at a significantly higher risk of major adverse cardiovascular events at 5\u00a0years compared with group 1 (group 2: adjusted hazard ratio [HR\n adjusted<\/jats:sub>\n ], 2.88; 95% CI, 1.52\u20137.19;\n P<\/jats:italic>\n =0.024; group 4: HR\n adjusted<\/jats:sub>\n , 4.00; 95% CI, 1.41\u201311.35;\n P<\/jats:italic>\n =0.009).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In stable patients with nonobstructive coronary stenoses, a diagnosis of INOCA based only on abnormal NIT did not identify patients with higher risk of long\u2010term cardiovascular events. Incorporating intracoronary physiologic assessment to NIT information in patients with nonobstructive disease allowed identification of patient subgroups with up to 4\u2010fold difference in long\u2010term cardiovascular events.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n \n URL:\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n ; Unique identifier: NCT04485234.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.121.025171","type":"journal-article","created":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T09:41:30Z","timestamp":1651052490000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Clinical Relevance of Ischemia with Nonobstructive Coronary Arteries According to Coronary Microvascular Dysfunction"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2337-7826","authenticated-orcid":false,"given":"Seung Hun","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine Chonnam National University HospitalChonnam National University Medical School Gwangju Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4960-5732","authenticated-orcid":false,"given":"Doosup","family":"Shin","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2178-4014","authenticated-orcid":false,"given":"Joo Myung","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim P.","family":"van de Hoef","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam UMC \u2013 location AMC Amsterdam The Netherlands"},{"name":"Department of Cardiology Amsterdam UMC \u2013 location VUmc Amsterdam The Netherlands"},{"name":"Department of Cardiology NoordWest Ziekenhuisgroep The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0623-0486","authenticated-orcid":false,"given":"David","family":"Hong","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki Hong","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doyeon","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cardiovascular CenterSeoul National University Hospital Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1515-9623","authenticated-orcid":false,"given":"Coen K. 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