Author + information
- Received November 4, 2019
- Revision received November 7, 2019
- Accepted November 7, 2019
- Published online January 6, 2020.
- Thomas J. Ford, PhDa,b,c,
- Bethany Stanley, MScd,
- Novalia Sidik, MBChBb,
- Richard Good, MDa,
- Paul Rocchiccioli, PhDa,b,
- Margaret McEntegart, PhDa,b,
- Stuart Watkins, MDa,
- Hany Eteiba, MDa,
- Aadil Shaukat, MBChBa,
- Mitchell Lindsay, MDa,
- Keith Robertson, PhDa,
- Stuart Hood, MDa,
- Ross McGeoch, MDe,
- Robert McDade, BNa,
- Eric Yii, MBChBb,
- Peter McCartney, MBChBb,
- David Corcoran, PhDb,
- Damien Collison, MB BCha,b,
- Christopher Rush, MBChBb,
- Naveed Sattar, PhDb,
- Alex McConnachie, PhDd,
- Rhian M. Touyz, PhDb,
- Keith G. Oldroyd, MD(Hons)a,b and
- Colin Berry, PhDa,b,∗ ()
- aWest of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
- bBritish Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- cGosford Hospital, NSW Health, Gosford, Australia
- dRobertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- eUniversity Hospital Hairmyres, East Kilbride, United Kingdom
- ↵∗Address for correspondence:
Prof. Colin Berry, British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, 126 University Place, University of Glasgow, Glasgow, G12 8TA, United Kingdom.
Objectives The aim of this study was to test the hypothesis that invasive coronary function testing at time of angiography could help stratify management of angina patients without obstructive coronary artery disease.
Background Medical therapy for angina guided by invasive coronary vascular function testing holds promise, but the longer-term effects on quality of life and clinical events are unknown among patients without obstructive disease.
Methods A total of 151 patients with angina with symptoms and/or signs of ischemia and no obstructive coronary artery disease were randomized to stratified medical therapy guided by an interventional diagnostic procedure versus standard care (control group with blinded interventional diagnostic procedure results). The interventional diagnostic procedure–facilitated diagnosis (microvascular angina, vasospastic angina, both, or neither) was linked to guideline-based management. Pre-specified endpoints included 1-year patient-reported outcome measures (Seattle Angina Questionnaire, quality of life [EQ-5D]) and major adverse cardiac events (all-cause mortality, myocardial infarction, unstable angina hospitalization or revascularization, heart failure hospitalization, and cerebrovascular event) at subsequent follow-up.
Results Between November 2016 and December 2017, 151 patients with ischemia and no obstructive coronary artery disease were randomized (n = 75 to the intervention group, n = 76 to the control group). At 1 year, overall angina (Seattle Angina Questionnaire summary score) improved in the intervention group by 27% (difference 13.6 units; 95% confidence interval: 7.3 to 19.9; p < 0.001). Quality of life (EQ-5D index) improved in the intervention group relative to the control group (mean difference 0.11 units [18%]; 95% confidence interval: 0.03 to 0.19; p = 0.010). After a median follow-up duration of 19 months (interquartile range: 16 to 22 months), major adverse cardiac events were similar between the groups, occurring in 9 subjects (12%) in the intervention group and 8 (11%) in the control group (p = 0.803).
Conclusions Stratified medical therapy in patients with ischemia and no obstructive coronary artery disease leads to marked and sustained angina improvement and better quality of life at 1 year following invasive coronary angiography. (Coronary Microvascular Angina [CorMicA]; NCT03193294)
- coronary physiology
- elective coronary angiography
- microvascular angina
- stable angina pectoris
- stratified medicine
- vasospastic angina
This investigator-initiated clinical trial was funded by the British Heart Foundation (PG/17/2532884, RE/13/5/30177, and RE/18/6134217). Dr. Berry is employed by the University of Glasgow, which holds consultancy and research agreements with Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Coroventis, GlaxoSmithKline, HeartFlow, Menarini, Opsens, Philips, and Siemens Healthcare. Dr. Oldroyd has received consulting and speaking fees from Abbott Vascular and Boston Scientific. Dr. Watkins has received consulting and speaking fees from Boston Scientific. Dr. Rocchiccioli has received consulting and speaking fees from AstraZeneca. Dr. Robertson has received educational support from Abbott Vascular and speaking fees from AstraZeneca. Dr. Touyz has acted as an advisor for Novartis. Dr. McEntegart has a proctoring agreement with Boston Scientific and Vascular Perspectives. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 4, 2019.
- Revision received November 7, 2019.
- Accepted November 7, 2019.
- 2020 The Authors