Ischemia in non-obstructive CAD in Italy: the INOCA-IT multicenter registry
Bibliographic record
Abstract
Abstract Background Despite increasing awareness, INOCA is underdiagnosed. Our study aims to assess the prevalence of INOCA in 3 centers in Northern, Central, and Southern Italy, stratifying patients based on coronary microvascular dysfunction (CMD), vasospastic angina (VSA), microvascular spasm (MSA), or non-cardiac origins (NCO), implementing tailored medical therapy and evaluating impact on angina severity, quality of life, and cardiac outcomes at 1 year. Methods The INOCA IT Multicenter Registry is a prospective, multicenter, single-arm clinical study that included patients presenting with CCS symptoms and/or positive stress tests, and non-obstructive CAD on coronary angiography.Invasive coronary functional testing was performed, assessing Coronary Flow Reserve (CFR), Index of Microvascular Resistance (IMR). Acetylcholine (ACh) spasm provocation test was also conducted to identify abnormal vasoreactivity. Patients were consequently classified into different INOCA endotypes and received personalized medical therapy. Patients underwent 1-year clinical follow-up. Results A total of 212 patients were enrolled, the mean age was 61±11 years and 60.4% were female. Overall, 64.2% of patients suffered from hypertension, 15.6% had diabetes, the mean BMI was 26.8±4.7 and 72.6% suffered from dyslipidemia. Most patients presented with typical chest pain (86.8%), the median Canadian Cardiovascular Society (CCS) grade was 2(IQR 2-3) and the median New York Heart Association (NHYA) class median 2 (IQR 1-2). At invasive coronary functional testing (mean CFR: 3.25±1.78, mean IMR 22.1±15.0), 22.6% of patients were diagnosed with CMD, 22.2% with VSA, 14.2% with MSA, 16.0% were affected by both CMD and VSA, 3.8% had both CMD and MVA, 21.2% patients had NCO symptoms.The prevalence of INOCA endotypes showed geographical differences: the first endotype in northern Italy was VSA (27.5%), CMD was the first in central Italy (28.9%), whereas most patients from southern Italy had chest pain of NCO (32.1%) – p for overall comparisons =0.028. The latter also had the highest prevalence of hypertension (83.9%vs52.5% and 61.8% in the other areas, p<0.01) and dyslipidemia (85.7vs 65.0 and 71.1 in the other areas, p=0.026). Moreover, male patients were more frequently affected by VSA compared to other endotypes in northern Italy (37.5%, p for overall comparison=0.043). Finally, VSA was the most frequently misdiagnosed endotype upon non-invasive diagnostic work-up, with a false negative rate of 78.8%, whereas CMD was identified more frequently, with a true positive rate of 50%. The last patient was enrolled in March 2024, and 1-year follow will be available at the time of presentation. Conclusions This real-world analysis highlights the importance of providing accurate diagnosis and subsequent tailored therapy to INOCA patients with a safe and systematical approach. We expect to detect improved QOL and angina symptoms following optimization of medical therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".