Persistent chest pain trends at 3 years in women with INOCA vs. obstructive CAD: results from the NHLBI-sponsored women’s ischemia syndrome evaluation (WISE)

Individuals with suspected ischaemia but no obstructive coronary arteries (INOCA) experience persistent chest pain (PChP) at rates comparable to those with obstructive coronary artery disease (CAD). We analysed the National Heart, Lung, and Blood Institute-sponsored Women’s Ischaemia Syndrome Evaluation (WISE) (NCT00000554) to compare patterns in chest pain persistence, cardiac medication use, and major adverse cardiovascular events (MACE) among women with INOCA and those with obstructive CAD.

There were 624 participants from WISE who met the inclusion criteria for this analysis (19% non-white, mean age = 58.0 years). Chest pain status was classified based on symptoms reported during the first 3 years of follow-up. Baseline predictors of 3-year chest pain status were assessed by Chi-square, and a log-rank test was used to compare 6-year outcomes by status. At 3 years, overall 26% of participants had persistent, 14% had intermediate, 27% had recurrent, and 34% had resolved chest pain. PChP prevalence was comparable in the INOCA group and the obstructive CAD groups (27% vs. 24%, P = 0.06). MACE occurrence was not significantly associated with 3-year chest pain status in either the INOCA or obstructive CAD groups. However, hospitalization for angina was associated with chest pain status (P < 0.001).

Women with INOCA experience a comparable burden of chest pain to those with obstructive CAD, yet lower rates of medical therapy at baseline and over time. Based on our findings, chest pain status at 3 years predicts angina hospitalizations but not MACE in women with or without obstructive CAD.