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Coronary Microvascular Dysfunction

Diagnosis and Referral for Health Care Practitioners (HCPs)

CMD Diagnosis and Referral

Confirmatory Diagnosis for Coronary Microvascular Dysfunction (CMD) to Improve Patient Quality of Life (QOL)1,3

To discover the root cause of persistent angina, patients may need an accurate diagnosis that requires more than the angiogram alone.1

Comprehensive physiology testing of both the epicardial arteries and microcirculation, with new technologies available through partnership with your interventional cardiologist, can provide a clear assessment of Coronary Microvascular Dysfunction (CMD) to help guide treatment and outcomes.2 As CMD is no longer a diagnosis of exclusion, a clear diagnosis of CMD can help patients take the first step to improve their Quality of Life (QoL).3

The Optimal Patient Pathway
Filippo Crea, IT

Diagnosing CMD Can Have a Clinical and Economic Impact

The CorMicA (CORonary MICrovascular Angina) study revealed that patients may benefit when CMD is accurately diagnosed and appropriately treated, with patients showing a 27% improvement in angina severity following diagnosis at 12 months.3

An accurate CMD diagnosis can help reduce healthcare resource consumption,2 resulting in lower costs for hospitals and patients4 with a savings from $2,100 (Netherlands) to $7,300 (U.S.) per hospitalization avoided (2017 costs).5 Additionally, an economic analysis of the CorMicA study showed that a comprehensive physiology assessment is cost-effective compared to standard care (medical therapy and cardiac rehabilitation care) at 1-year follow-up.6

27% Improvement in Angina Severity


PressureWire™ X Guidewire and CoroFlow‡ Cardiovascular System are the only* solution for the cath lab to enable a diagnosis of both epicardial disease and CMD by physicians.3,7
 

Connect with your interventional cardiologist to determine how the PressureWire™ X Guidewire and CoroFlow‡ Cardiovascular System can benefit your patients with no angiographic abnormalities.

Learn more about PressureWire™ X Guidewire and CoroFlow‡ Cardiovascular System.

PressureWire™ X Guidewire and CoroFlow‡ Cardiovascular System

Guidelines for Assessing Persistent Angina

European and American guidelines provide a class 2a recommendation for a physiology wire-based assessment for patients with stable chest pain and/Ischemia and No Obstructive Coronary Artery Disease (INOCA).8,9

The ESC guidelines8 2019 were updated accordingly to include an increased focus on microvascular dysfunction.
 

Recommendations


The AHA/ACC Clinical Practice Guideline9 on chest pain includes Class IIa recommendation for guidewire-based assessment for ischemia and no obstructed coronary artery disease (INOCA) patients.
 

Recommendations for patients with INOCA

CFR = coronary flow reserve; CMR = cardiac magnetic resonance; ECG = electrocardiogram;
FFR = fractional flow reserve; iwFR = instantaneous wave-free ratio; LAD = left anterior descending; PET = position emission tomography.

a Class of recommendation

b Level of evidence

Level-NR: Level (Quality) of Evidence Level B-NR (non-randomized): moderate-quality evidence from 1 or more well-designed, well-executed non-randomized studies, observational studies or registry studies. RCTs. Meta-analyses of such studies.
 

*With Index of Microcirculatory Resistance (IMR), Coronary Flow Reserve (CFR), Fractional Flow Reserve (FFR) and Resting Full-Cycle Ratio (RFR).
 

References

  1. Taqueti, VR., et al. Coronary microvascular disease pathogenic mechanisms and therapeutic options: JACC state-of-the-art review. J Am Coll Cardiol. 2018;72:2625–2641.
  2. Lee, B., et al. Invasive evaluation of patients with angina in the absence of obstructive coronary artery disease. Circulation. 2015;131:1054-1060.
  3. Ford, TJ., et al. 1-year outcomes of angina management guided by invasive coronary function testing (CorMicA). JACC Intv. 2020: 13:33-45.
  4. Reriani, M., et al. Coronary endothelial function testing may improve long-term quality of life in subjects with microvascular coronary endothelial dysfunction. Open Heart. 2019:6:e000870.
  5. Omerovic, E., et al. FFR-Guided Complete Revascularization During Primary Angioplasty: Effects on Societal Costs. EuroPCR 2017.
  6. Heggie, R., et al. A cost-effectiveness analysis of the BHF CorMicA Trial. Interventional Journal of Cardiology 2021. Doi:10.1016/j.ijcard.2021.05.016
  7. PressureWire™ X Guidewire Instructions for Use (IFU). Refer to IFU for additional information. CoroFlow‡ Cardiovascular System IFU. Refer to IFU for additional information.
  8. Knuuti, J., et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal 2020:41,407-477
  9. Gulati, M., et al. 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain. Circulation 2021;144e368-3454.

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