Association between coronary vasomotor dysfunction and autoimmune disease in patients undergoing invasive coronary function testing

Background Autoimmune diseases (AD) are associated with increased cardiovascular risk, but their relationship with coronary vasomotor dysfunction (CVDys) in patients with angina with nonobstructive coronary arteries (ANOCA) remains unclear. Methods We retrospectively analyzed 242 adults with ANOCA who underwent invasive coronary function testing. Patients were categorized by AD status, with systemic and organ-specific AD also evaluated separately. CVDys endotypes, including coronary microvascular dysfunction (CMD), vasospastic angina (VSA), and endothelial dysfunction, were compared using adjusted risk ratios. Clinical outcomes were assessed with time-to-event analyses. Results Of 242 patients (74.8% female), 91 (37.6%) had AD. CVDys was common in both patients with and without AD (81.3% vs 80.8%; p = 0.71). Among patients with AD, VSA and endothelial dysfunction were the most prevalent endotypes (28.6% each). Organ-specific AD showed numerically higher risks of CMD (adjusted RR, 1.47; 95% CI, 0.94–2.30; p = 0.093) and endothelial dysfunction (adjusted RR, 1.58; 95% CI, 0.98–2.55; p = 0.062), although neither association was statistically significant. Adjusted event-free survival did not differ among the normal-physiology, no AD + CVDys, and AD + CVDys groups ( p = 0.155). Among patients with CVDys, AD was not associated with chest-pain hospitalization (HR, 0.65; 95% CI, 0.26–1.63; p = 0.356). Conclusions Autoimmune disease was not associated with higher CVDys prevalence or adverse cardiovascular outcomes in patients with ANOCA undergoing invasive CFT. Invasive testing identified diverse CVDys endotypes among patients with AD, supporting the utility of comprehensive phenotyping in this population.