1. 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA)
- Author
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Keith G. Oldroyd, Robert McDade, Alex McConnachie, Christopher Rush, Colin Berry, Novalia Sidik, Eric Yii, Mitchell Lindsay, Rhian M. Touyz, Bethany Stanley, Ross McGeoch, David Corcoran, Richard Good, Naveed Sattar, Paul Rocchiccioli, Peter McCartney, Stuart Watkins, Stuart Hood, Hany Eteiba, Thomas J. Ford, Margaret McEntegart, Aadil Shaukat, Keith Robertson, and Damien Collison
- Subjects
Male ,BP, blood pressure ,Cardiac Catheterization ,Time Factors ,Heart disease ,medicine.medical_treatment ,CAD, coronary artery disease ,VSA, vasospastic angina ,stratified medicine ,Coronary ,elective coronary angiography ,RR, relative risk ,030204 cardiovascular system & hematology ,Coronary Angiography ,Severity of Illness Index ,Coronary artery disease ,Angina ,0302 clinical medicine ,Cause of Death ,030212 general & internal medicine ,Myocardial infarction ,medicine.diagnostic_test ,CFR, coronary flow reserve ,Middle Aged ,stable angina pectoris ,Fractional Flow Reserve, Myocardial ,MACE, major adverse cardiac event(s) ,Treatment Outcome ,Patient Satisfaction ,Cardiology ,Disease Progression ,Female ,Cardiology and Cardiovascular Medicine ,FFR, fractional flow reserve ,SAQSS, Seattle Angina Questionnaire summary score ,medicine.medical_specialty ,coronary physiology ,Clinical Decision-Making ,vasospastic angina ,IDP, interventional diagnostic procedure ,Revascularization ,Angina Pectoris ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Aged ,Unstable angina ,business.industry ,ACh, acetylcholine ,Cardiovascular Agents ,MVA, microvascular angina ,Recovery of Function ,medicine.disease ,SAQ, Seattle Angina Questionnaire ,CI, confidence interval ,Scotland ,Heart failure ,microvascular angina ,Angiography ,Quality of Life ,business - Abstract
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, Central Illustration
- Published
- 2020