Abstract 11846: Baseline Coronary Flow Velocity Predicts Adverse Outcomes in Women With Suspected Ischemia and No Obstructive Coronary Arteries: Results From the Women's Ischemia Syndrome Evaluation (WISE) Long-Term Follow-Up.

Introduction: Impaired coronary flow reserve (CFR) to adenosine predicts adverse outcomes in women with suspected ischemia and no obstructive coronary arteries (INOCA). CFR (ratio of hyperemic to resting coronary blood flow) is a measure of coronary vasomotor dysfunction. We investigated whether resting coronary flow velocity predicts adverse outcomes among women with INOCA. Methods: As part of the WISE, we evaluated relationships between major adverse cardiac events (as first occurrence of death, myocardial infarction, stroke, or heart failure hospitalization), baseline average peak coronary blood flow velocity (bAPV), and CFR to intracoronary adenosine (hyperemic APV/bAPV) in 150 women with INOCA. Four patient groups were identified based on impaired CFR <2.32 and bAPV <22, per prior studies. Results: A total of 33 (22%) events occurred over a median follow-up of 5.9 years (Table). Among the groups, there were no significant differences in pertinent baseline characteristics (age, BMI, ethnicity, cardiac risk factors, medications, WISE coronary severity score, heart rate) except systolic blood pressure. Women with preserved CFR and low bAPV had the lowest risk of MACE (group 2, 13.2%), while women with impaired CFR and low bAPV had the highest risk (group 4, 41.2%) (Figure, log rank test p =0.0063). Women with high bAPV had intermediate risk regardless of CFR (group 1: 28.6%; group 3: 24.3%). Conclusions: Among women with INOCA, integrating CFR and resting coronary flow velocity provides unique prognostic information. These findings suggest that a high resting coronary flow velocity is associated with worse outcomes even in the setting of preserved CFR in women with INOCA. [ABSTRACT FROM AUTHOR]