Author + information
- Thomas J. Ford, Dr, MBChB (Hons), FRACP1,2,3,
- Bethany Stanley, Ms, MSc5,
- Novalia Sidik, Dr, MBChB2,
- Richard Good, Dr, MD1,
- Paul Rocchiccioli, Dr., PhD1,2,
- Margaret McEntegart, Dr, PhD1,2,
- Stuart Watkins, Dr, MD1,
- Hany Eteiba, Professor, MD1,
- Aadil Shaukat, Dr, FRCP1,
- Mitchell Lindsay, Dr, MD1,
- Keith Robertson, Dr, PhD1,
- Stuart Hood, Dr, MD1,
- Ross McGeoch, Dr, MD4,
- Robert McDade, Mr, BN1,
- Eric Yii, Dr, MBChB2,
- Peter McCartney, Dr, MBChB2,
- David Corcoran, Dr, MBChB2,
- Damien Collison, Dr, MB BCh1,2,
- Christopher Rush, Dr, MBChB2,
- Naveed Sattar, Prof, PhD2,
- Alex McConnachie, Professor, PhD5,
- Rhian M. Touyz, Professor, PhD2,
- Keith G. Oldroyd, Professor, MD(Hons)1,2 and
- Colin Berry, Professor, PhD1,2,∗ ()
- 1West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, UK
- 2British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
- 3Gosford Hospital, NSW Health, Australia
- 4University Hospital Hairmyres, East Kilbride, UK
- 5Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow
Professor Colin Berry, British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, 126 University Place, University of Glasgow, Glasgow, G12 8TA, Scotland, UK. Telephone: +44 (0) 141 330 3325 or +44 (0) 141 951 5180. Fax +44 (0) 141 330 6794.
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 151 angina patients with symptoms and/or signs of ischemia and no obstructive coronary artery disease (INOCA) were randomized to stratified medical therapy guided by an interventional diagnostic procedure (IDP) versus standard care (control group with blinded IDP results). The IDP-facilitated diagnosis (microvascular angina, vasospastic angina, both, neither) was linked to guideline-based management. Prespecified endpoints included 1-year patient reported outcome measures (Seattle Angina Questionnaire [SAQ], quality of life [EQ5D]) and major adverse cardiovascular events (all- cause mortality, myocardial infarction, unstable angina hospitalization/revascularization, heart failure hospitalization, cerebrovascular event) at subsequent follow-up.
Results Between 11/2016-12/2017 151 INOCA patients were randomized (n=75 intervention group; n=76 control group). At 1 year, overall angina (SAQ summary score) improved in the intervention group by 27% (difference 13.6 units; 95% CI 7.3 to 19.9,P<0.001). Quality of life (EQ5D index) improved in the intervention group relative to the control group (mean difference 0.11 units [18%]; 0.03 to 0.19;p=0.010). After a median follow-up of 19 months (IQR 16, 22), MACE was similar between the groups occuring in 9 (12%) subjects in the intervention group and 8 (11%) in the control group (p=0.803).
Conclusion Stratified medical therapy in INOCA patients leads to marked and sustained angina improvement and better quality of life at 1 year following invasive coronary angiography.
- Coronary physiology
- stratified medicine
- stable angina pectoris
- elective coronary angiography
- microvascular angina
- vasospastic angina
Statement of competing interests: C.B. is employed by the University of Glasgow which holds consultancy and research agreements with Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Coroventis, GSK, HeartFlow, Menarini, Opsens, Philips, and Siemens Healthcare. K.G.O. has received consultant and speaker fees from Abbott Vascular and Boston Scientific. S.W. has received consultant and speaker fees from Boston Scientific. P.R. has received consultant and speaker fees from Astra Zeneca. K.R has received educational support from Abbott Vascular and speaker fees from Astra Zeneca. RMT has acted as an advisor for Novartis. MME has a proctoring agreement with Boston Scientific and Vascular Perspectives.
- Received November 4, 2019.
- Revision received November 7, 2019.
- Accepted November 7, 2019.
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