TCT-676 Incidence of Coronary Microvascular Dysfunction in ANOCA Patients With and Without a History of Severe Covid-19 Infection: The COMET-19 Study

Abstract

Background
Post-acute sequelae of SARS-CoV-2 infection can manifest as anginal chest pain. However, the underlying mechanisms, including the role of coronary microvascular dysfunction (CMD), remain elusive. We investigated the CMD incidence and endotypes in angina without obstructive coronary artery disease (ANOCA) patients with a history of severe Covid-19 infection.

Methods
COMET-19 (NCT05841485) is a multicentre, prospective cross-sectional study including 117 consecutive ANOCA patients: 59 with a history of severe Covid-19 infection (Covid group) and 58 without (control group). All patients underwent coronary physiology assessment for fractional flow reserve (FFR), coronary flow reserve (CFR), and index of microvascular resistance (IMR). CMD was defined as CFR <2.0 or IMR ≥25, with functional CMD defined as CFR <2.0 and IMR <25 and structural CMD defined as CFR <2.0 and IMR ≥25.

Results
The incidence of CMD was 47.5% (n = 28) in the Covid group and 24.1% (n = 14) in the control group (P = 0.015), predominantly driven by the higher incidence of structural CMD in the Covid group (28.8% vs 5.8%; P < 0.001), whereas functional CMD was more common in the control group (19.0% vs 6.8%; P < 0.001). (FigA,B) Compared with the control group, Covid patients had significantly higher IMR (20.0 [15.0-42.0] vs 17.0 [12.0, 21.0]; P = 0.002) but similar FFR (0.89 vs 0.9; P = 0.327) and CFR (2.68 vs 2.74; P = 0.540).

Conclusions
ANOCA patients with a history of severe Covid-19 infection had a higher incidence of CMD, particularly structural CMD, suggesting a link between Covid-19 and microvascular impairment.