Objective To evaluate the value of cold press test (CPT) myocardial perfusion imaging (MPI) in the diagnosis of vasospastic angina pectoris in patients with ischaemia and non-obstructive coronary arteries (INOCA).

Methods A retrospective analysis was conducted on 676 suspected INOCA patients with angina pectoris or chest tightness, wheezing, and other equivalent symptoms of angina pectoris in Xuzhou Central Hospital from January 2019 to June 2023. The sample included 439 males and 237 females, aged (49.3±20.4) years. All patients underwent CPT and resting MPI. In accordance with 2019 expert consensus for key points of technique and image process during SPECT myocardial perfusion imaging, the degree of myocardial ischemia in the patients was assessed. Semiquantitative parameters, such as summed stress score (SSS), summed resting score, and total perfusion defect (TPD), were calculated. One-way ANOVA was used to compare the measurement data with a normal distribution, and the χ² test was employed to compare the counting data.

Results The number of patients with negative CPT MPI results (CPT (−) group) and positive results (CPT (+) group) was 202 and 474, respectively. A significant difference in the proportion of patients with anxiety symptoms was observed between the two groups (14.9% vs. 89.9%; χ²=4.667, P<0.05). No significant differences in the other general data was found between the two groups (t=1.009, χ²=0.136–3.042; all P>0.05). According to the SSS results, 299 (44.2%) patients had mild myocardial ischemia, 156 (23.1%) patients had moderate myocardial ischemia, and 19 (2.8%) patients had severe myocardial ischemia. The TPD results revealed that 318 (47.0%) patients had mild myocardial ischemia, 136 (20.1%) patients had moderate myocardial ischemia, and 20 (3.0%) patients had severe myocardial ischemia. On the basis of the location of ischemia, 331 (49.0%), 349 (51.6%), and 277 (41.0%) patients were determined to have transmural myocardial ischemia, apical myocardial ischemia, and subendocardial myocardial ischemia, respectively.

Conclusion CPT MPI can diagnostically evaluate myocardial ischemia caused by vasospastic angina pectoris in patients with INOCA and provide an important reference for noninvasive imaging diagnosis of this kind of patients.