Stratified Medical Therapy Using Invasive Coronary Function Testing in Angina

Stratified Medical Therapy Using Invasive Coronary Function Testing in Angina. Ford, T. J., Stanley, B., Good, R., Rocchiccioli, P., McEntegart, M., Watkins, S., Eteiba, H., Shaukat, A., Lindsay, M., Robertson, K., Hood, S., McGeoch, R., McDade, R., Yii, E., Sidik, N., McCartney, P., Corcoran, D., Collison, D., Rush, C., McConnachie, A., Touyz, R. M., Oldroyd, K. G., & Berry, C. Journal of the American College of Cardiology, 72(23):2841–2855, December, 2018.

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BACKGROUND Patients with angina symptoms and/or signs of ischemia but no obstructive coronary artery disease (INOCA) pose a diagnostic and therapeutic challenge. OBJECTIVES The purpose of this study was to test whether an interventional diagnostic procedure (IDP) linked to stratiﬁed medicine improves health status in patients with INOCA. METHODS The authors conducted a randomized, controlled, blinded clinical trial of stratiﬁed medical therapy versus standard care in patients with angina. Patients with angina undergoing invasive coronary angiography (standard care) were recruited. Patients without obstructive CAD were immediately randomized 1:1 to the intervention group (stratiﬁed medical therapy) or the control group (standard care, IDP sham procedure). The IDP consisted of guidewire-based assessment of coronary ﬂow reserve, index of microcirculatory resistance, fractional ﬂow reserve, followed by vasoreactivity testing with acetylcholine. The primary endpoint was the mean difference in angina severity at 6 months (assessed by the Seattle Angina Questionnaire summary score). RESULTS A total of 391 patients were enrolled between November 25, 2016, and November 12, 2017. Coronary angiography revealed obstructive disease in 206 (53.7%). One hundred ﬁfty-one (39%) patients without angiographically obstructive CAD were randomized (n ¼ 76 intervention group; n ¼ 75 blinded control group). The intervention resulted in a mean improvement of 11.7 U in the Seattle Angina Questionnaire summary score at 6 months (95% conﬁdence interval [CI]: 5.0 to 18.4; p ¼ 0.001). In addition, the intervention led to improvements in the mean quality-of-life score (EQ-5D index 0.10 U; 95% CI: 0.01 to 0.18; p ¼ 0.024) and visual analogue score (14.5 U; 95% CI: 7.8 to 21.3; p \textless 0.001). There were no differences in major adverse cardiac events at the 6-month follow-up (2.6% controls vs. 2.6% intervention; p ¼ 1.00). CONCLUSIONS Coronary angiography often fails to identify patients with vasospastic and/or microvascular angina. Stratiﬁed medical therapy, including an IDP with linked medical therapy, is routinely feasible and improves angina in patients with no obstructive CAD. (CORonary MICrovascular Angina [CorMicA]; NCT03193294) (J Am Coll Cardiol 2018;72:2841–55) © 2018 by the American College of Cardiology Foundation.

@article{ford_stratified_2018-1,
	title = {Stratified {Medical} {Therapy} {Using} {Invasive} {Coronary} {Function} {Testing} in {Angina}},
	volume = {72},
	issn = {07351097},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S0735109718383815},
	doi = {10.1016/j.jacc.2018.09.006},
	abstract = {BACKGROUND Patients with angina symptoms and/or signs of ischemia but no obstructive coronary artery disease (INOCA) pose a diagnostic and therapeutic challenge. OBJECTIVES The purpose of this study was to test whether an interventional diagnostic procedure (IDP) linked to stratiﬁed medicine improves health status in patients with INOCA. METHODS The authors conducted a randomized, controlled, blinded clinical trial of stratiﬁed medical therapy versus standard care in patients with angina. Patients with angina undergoing invasive coronary angiography (standard care) were recruited. Patients without obstructive CAD were immediately randomized 1:1 to the intervention group (stratiﬁed medical therapy) or the control group (standard care, IDP sham procedure). The IDP consisted of guidewire-based assessment of coronary ﬂow reserve, index of microcirculatory resistance, fractional ﬂow reserve, followed by vasoreactivity testing with acetylcholine. The primary endpoint was the mean difference in angina severity at 6 months (assessed by the Seattle Angina Questionnaire summary score). RESULTS A total of 391 patients were enrolled between November 25, 2016, and November 12, 2017. Coronary angiography revealed obstructive disease in 206 (53.7\%). One hundred ﬁfty-one (39\%) patients without angiographically obstructive CAD were randomized (n ¼ 76 intervention group; n ¼ 75 blinded control group). The intervention resulted in a mean improvement of 11.7 U in the Seattle Angina Questionnaire summary score at 6 months (95\% conﬁdence interval [CI]: 5.0 to 18.4; p ¼ 0.001). In addition, the intervention led to improvements in the mean quality-of-life score (EQ-5D index 0.10 U; 95\% CI: 0.01 to 0.18; p ¼ 0.024) and visual analogue score (14.5 U; 95\% CI: 7.8 to 21.3; p {\textbackslash}textless 0.001). There were no differences in major adverse cardiac events at the 6-month follow-up (2.6\% controls vs. 2.6\% intervention; p ¼ 1.00). CONCLUSIONS Coronary angiography often fails to identify patients with vasospastic and/or microvascular angina. Stratiﬁed medical therapy, including an IDP with linked medical therapy, is routinely feasible and improves angina in patients with no obstructive CAD. (CORonary MICrovascular Angina [CorMicA]; NCT03193294) (J Am Coll Cardiol 2018;72:2841–55) © 2018 by the American College of Cardiology Foundation.},
	language = {en},
	number = {23},
	urldate = {2021-04-28},
	journal = {Journal of the American College of Cardiology},
	author = {Ford, Thomas J. and Stanley, Bethany and Good, Richard and Rocchiccioli, Paul and McEntegart, Margaret and Watkins, Stuart and Eteiba, Hany and Shaukat, Aadil and Lindsay, Mitchell and Robertson, Keith and Hood, Stuart and McGeoch, Ross and McDade, Robert and Yii, Eric and Sidik, Novalia and McCartney, Peter and Corcoran, David and Collison, Damien and Rush, Christopher and McConnachie, Alex and Touyz, Rhian M. and Oldroyd, Keith G. and Berry, Colin},
	month = dec,
	year = {2018},
	pages = {2841--2855},
	file = {Ford et al. - 2018 - Stratified Medical Therapy Using Invasive Coronary.pdf:/Users/neil.hawkins/Zotero/storage/VDPUUFKJ/Ford et al. - 2018 - Stratified Medical Therapy Using Invasive Coronary.pdf:application/pdf},
}

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OBJECTIVES The purpose of this study was to test whether an interventional diagnostic procedure (IDP) linked to stratiﬁed medicine improves health status in patients with INOCA. METHODS The authors conducted a randomized, controlled, blinded clinical trial of stratiﬁed medical therapy versus standard care in patients with angina. Patients with angina undergoing invasive coronary angiography (standard care) were recruited. Patients without obstructive CAD were immediately randomized 1:1 to the intervention group (stratiﬁed medical therapy) or the control group (standard care, IDP sham procedure). The IDP consisted of guidewire-based assessment of coronary ﬂow reserve, index of microcirculatory resistance, fractional ﬂow reserve, followed by vasoreactivity testing with acetylcholine. The primary endpoint was the mean difference in angina severity at 6 months (assessed by the Seattle Angina Questionnaire summary score). RESULTS A total of 391 patients were enrolled between November 25, 2016, and November 12, 2017. Coronary angiography revealed obstructive disease in 206 (53.7%). One hundred ﬁfty-one (39%) patients without angiographically obstructive CAD were randomized (n ¼ 76 intervention group; n ¼ 75 blinded control group). The intervention resulted in a mean improvement of 11.7 U in the Seattle Angina Questionnaire summary score at 6 months (95% conﬁdence interval [CI]: 5.0 to 18.4; p ¼ 0.001). In addition, the intervention led to improvements in the mean quality-of-life score (EQ-5D index 0.10 U; 95% CI: 0.01 to 0.18; p ¼ 0.024) and visual analogue score (14.5 U; 95% CI: 7.8 to 21.3; p \\textless 0.001). There were no differences in major adverse cardiac events at the 6-month follow-up (2.6% controls vs. 2.6% intervention; p ¼ 1.00). CONCLUSIONS Coronary angiography often fails to identify patients with vasospastic and/or microvascular angina. Stratiﬁed medical therapy, including an IDP with linked medical therapy, is routinely feasible and improves angina in patients with no obstructive CAD. (CORonary MICrovascular Angina [CorMicA]; NCT03193294) (J Am Coll Cardiol 2018;72:2841–55) © 2018 by the American College of Cardiology Foundation.","language":"en","number":"23","urldate":"2021-04-28","journal":"Journal of the American College of Cardiology","author":[{"propositions":[],"lastnames":["Ford"],"firstnames":["Thomas","J."],"suffixes":[]},{"propositions":[],"lastnames":["Stanley"],"firstnames":["Bethany"],"suffixes":[]},{"propositions":[],"lastnames":["Good"],"firstnames":["Richard"],"suffixes":[]},{"propositions":[],"lastnames":["Rocchiccioli"],"firstnames":["Paul"],"suffixes":[]},{"propositions":[],"lastnames":["McEntegart"],"firstnames":["Margaret"],"suffixes":[]},{"propositions":[],"lastnames":["Watkins"],"firstnames":["Stuart"],"suffixes":[]},{"propositions":[],"lastnames":["Eteiba"],"firstnames":["Hany"],"suffixes":[]},{"propositions":[],"lastnames":["Shaukat"],"firstnames":["Aadil"],"suffixes":[]},{"propositions":[],"lastnames":["Lindsay"],"firstnames":["Mitchell"],"suffixes":[]},{"propositions":[],"lastnames":["Robertson"],"firstnames":["Keith"],"suffixes":[]},{"propositions":[],"lastnames":["Hood"],"firstnames":["Stuart"],"suffixes":[]},{"propositions":[],"lastnames":["McGeoch"],"firstnames":["Ross"],"suffixes":[]},{"propositions":[],"lastnames":["McDade"],"firstnames":["Robert"],"suffixes":[]},{"propositions":[],"lastnames":["Yii"],"firstnames":["Eric"],"suffixes":[]},{"propositions":[],"lastnames":["Sidik"],"firstnames":["Novalia"],"suffixes":[]},{"propositions":[],"lastnames":["McCartney"],"firstnames":["Peter"],"suffixes":[]},{"propositions":[],"lastnames":["Corcoran"],"firstnames":["David"],"suffixes":[]},{"propositions":[],"lastnames":["Collison"],"firstnames":["Damien"],"suffixes":[]},{"propositions":[],"lastnames":["Rush"],"firstnames":["Christopher"],"suffixes":[]},{"propositions":[],"lastnames":["McConnachie"],"firstnames":["Alex"],"suffixes":[]},{"propositions":[],"lastnames":["Touyz"],"firstnames":["Rhian","M."],"suffixes":[]},{"propositions":[],"lastnames":["Oldroyd"],"firstnames":["Keith","G."],"suffixes":[]},{"propositions":[],"lastnames":["Berry"],"firstnames":["Colin"],"suffixes":[]}],"month":"December","year":"2018","pages":"2841–2855","file":"Ford et al. - 2018 - Stratified Medical Therapy Using Invasive Coronary.pdf:/Users/neil.hawkins/Zotero/storage/VDPUUFKJ/Ford et al. - 2018 - Stratified Medical Therapy Using Invasive Coronary.pdf:application/pdf","bibtex":"@article{ford_stratified_2018-1,\n\ttitle = {Stratified {Medical} {Therapy} {Using} {Invasive} {Coronary} {Function} {Testing} in {Angina}},\n\tvolume = {72},\n\tissn = {07351097},\n\turl = {https://linkinghub.elsevier.com/retrieve/pii/S0735109718383815},\n\tdoi = {10.1016/j.jacc.2018.09.006},\n\tabstract = {BACKGROUND Patients with angina symptoms and/or signs of ischemia but no obstructive coronary artery disease (INOCA) pose a diagnostic and therapeutic challenge. OBJECTIVES The purpose of this study was to test whether an interventional diagnostic procedure (IDP) linked to stratiﬁed medicine improves health status in patients with INOCA. METHODS The authors conducted a randomized, controlled, blinded clinical trial of stratiﬁed medical therapy versus standard care in patients with angina. Patients with angina undergoing invasive coronary angiography (standard care) were recruited. Patients without obstructive CAD were immediately randomized 1:1 to the intervention group (stratiﬁed medical therapy) or the control group (standard care, IDP sham procedure). The IDP consisted of guidewire-based assessment of coronary ﬂow reserve, index of microcirculatory resistance, fractional ﬂow reserve, followed by vasoreactivity testing with acetylcholine. The primary endpoint was the mean difference in angina severity at 6 months (assessed by the Seattle Angina Questionnaire summary score). RESULTS A total of 391 patients were enrolled between November 25, 2016, and November 12, 2017. Coronary angiography revealed obstructive disease in 206 (53.7\\%). One hundred ﬁfty-one (39\\%) patients without angiographically obstructive CAD were randomized (n ¼ 76 intervention group; n ¼ 75 blinded control group). The intervention resulted in a mean improvement of 11.7 U in the Seattle Angina Questionnaire summary score at 6 months (95\\% conﬁdence interval [CI]: 5.0 to 18.4; p ¼ 0.001). In addition, the intervention led to improvements in the mean quality-of-life score (EQ-5D index 0.10 U; 95\\% CI: 0.01 to 0.18; p ¼ 0.024) and visual analogue score (14.5 U; 95\\% CI: 7.8 to 21.3; p {\\textbackslash}textless 0.001). There were no differences in major adverse cardiac events at the 6-month follow-up (2.6\\% controls vs. 2.6\\% intervention; p ¼ 1.00). CONCLUSIONS Coronary angiography often fails to identify patients with vasospastic and/or microvascular angina. Stratiﬁed medical therapy, including an IDP with linked medical therapy, is routinely feasible and improves angina in patients with no obstructive CAD. (CORonary MICrovascular Angina [CorMicA]; NCT03193294) (J Am Coll Cardiol 2018;72:2841–55) © 2018 by the American College of Cardiology Foundation.},\n\tlanguage = {en},\n\tnumber = {23},\n\turldate = {2021-04-28},\n\tjournal = {Journal of the American College of Cardiology},\n\tauthor = {Ford, Thomas J. and Stanley, Bethany and Good, Richard and Rocchiccioli, Paul and McEntegart, Margaret and Watkins, Stuart and Eteiba, Hany and Shaukat, Aadil and Lindsay, Mitchell and Robertson, Keith and Hood, Stuart and McGeoch, Ross and McDade, Robert and Yii, Eric and Sidik, Novalia and McCartney, Peter and Corcoran, David and Collison, Damien and Rush, Christopher and McConnachie, Alex and Touyz, Rhian M. and Oldroyd, Keith G. and Berry, Colin},\n\tmonth = dec,\n\tyear = {2018},\n\tpages = {2841--2855},\n\tfile = {Ford et al. - 2018 - Stratified Medical Therapy Using Invasive Coronary.pdf:/Users/neil.hawkins/Zotero/storage/VDPUUFKJ/Ford et al. - 2018 - Stratified Medical Therapy Using Invasive Coronary.pdf:application/pdf},\n}\n\n","author_short":["Ford, T. 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