Ann Noninvasive Electrocardiol. 2026 May;31(3):e70168. doi: 10.1111/anec.70168.
ABSTRACT
INTRODUCTION: An estimated four million individuals have suspected Ischemia and No Obstructive Coronary Arteries (INOCA), often due to coronary microvascular dysfunction, a subtype of ischemic heart disease that disproportionately affects women. Previously hypothesized as a benign condition, patients with INOCA demonstrate an elevated risk profile for major adverse cardiovascular events (MACE), yet biomarkers to inform this risk have not been identified.
METHODS: To examine ECG indices as predictors of MACE among women with INOCA, we conducted a secondary analysis of the Women's Ischemia Syndrome Evaluation (WISE) original cohort in 481 women with suspected INOCA and complete data. Cox multivariable regression analysis was conducted in baseline ECG indices (intervals, rate, rhythm, and abnormalities) and their association with time-to-incident MACE (angina hospitalization, myocardial infarction, stroke, heart failure, revascularization with stent or angioplasty, or all-cause death). Cox proportional hazards modeling was performed as time from study enrollment to event censored on days to last contact, using stepwise backward selection and bootstrapping for model determination.
RESULTS: Overall, 165 (34.3%) experienced at least one MACE, including 26 (5.41%) all cause deaths, over an average follow-up time of 5.25 years. Significant predictors in the final model were resting heart rate (RHR), race, CHF, depression, and use of nitrates within 24 h of ECG measurement. Higher RHR was associated with increased hazards of incident composite MACE (adjusted hazard ratio 1.018, p = 0.0348).
CONCLUSION: Identifying unique biomarkers for MACE among women with INOCA is a clinical and research priority to inform screening and prevention strategies.
PMID:41902512 | DOI:10.1111/anec.70168