Microvascular vasomotor dysfunction is more prevalent in female versus epicardial vasomotor dysfunction in male ANOCA patients

Background: Coronary vasomotor dysfunction, diagnosed by coronary function testing (CFT), has only recently been recognized as important contributor to chronic coronary syndromes, exposing knowledge gaps on sex and age differences. Therefore, these differences are evaluated in the Dutch national CFT registry (NL-CFT). Methods: Included were 1008 patients (83% women, 60 ± 9.6 years old) with angina and non-obstructive coronary arteries (ANOCA) undergoing CFT between 2020 and 2024. CFT consisted of coronary vasospasm provocation testing and reduced microvascular vasodilatory capacity assessment, a decreased coronary flow reserve (CFR) and/or increased microvascular resistance (MR). Patients were allocated into three age groups based on quartiles: young (≤54 years, Q1), intermediate (>54 to <67 years, Q2–Q3), and elderly (≥67 years, Q4). Results: The prevalence of coronary vasomotor dysfunction was high, and similar (76%) between sexes. However, endotype prevalences differed: epicardial spasm was more prevalent in men in young and intermediate age groups (37%vs61%, p = 0.007 and 36%vs54%, p = 0.002), but not in elderly (44%vs32%, p = 0.096). Microvascular spasm was more prevalent in women in younger and intermediate groups (31%vs6%, p = 0.002 and 28%vs10%, p < 0.001), but not in elderly (27%vs22%, p = 0.493). Functional reduced microvascular vasodilatory capacity (abnormal CFR) was more prevalent in women (15%vs9%, p = 0.044), while structural reduced microvascular vasodilatory capacity (abnormal CFR and MR) prevalences were similar between sexes, across age groups. Conclusion: In ANOCA patients referred for CFT, epicardial spasm was more prevalent among men and microvascular spasm in women. Functional reduced microvascular vasodilatory capacity was more common in women in all age groups while structural reduced microvascular vasodilatory capacity was similar between sexes.