1-year outcomes of angina management guided by invasive coronary function testing (CorMicA)

Ford, T. J. et al. (2020) 1-year outcomes of angina management guided by invasive coronary function testing (CorMicA). JACC: Cardiovascular Interventions, 13(1), pp. 33-45. (doi: 10.1016/j.jcin.2019.11.001) (PMID:31709984)

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 < 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)

• Item Type: Articles
• Additional Information: Clinicaltrials.gov (NCT03193294). Investigator-initiated clinical trial that was funded by the British Heart Foundation (PG/17/2532884; RE/13/5/30177; RE/18/6134217).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McConnachie, Professor Alex and Stanley, Miss Bethany and Robertson, Dr Keith and Shaukat, Dr Aadil and Ford, Thomas and Collison, Dr Damien and McEntegart, Dr Margaret and McCartney, Dr Peter and Oldroyd, Dr Keith and Corcoran, Dr David and Touyz, Professor Rhian and Rush, Dr Christopher and Hood, Dr Stuart and Berry, Professor Colin and Eteiba, Professor Hany and Sattar, Professor Naveed and Sidik, Ms Novalia
• Authors: Ford, T. J., Stanley, B., Sidik, N., Good, R., Rocchiccioli, P., McEntegart, M., Watkins, S., Eteiba, H., Shaukat, A., Lindsay, M., Robertson, K., Hood, S., McGeoch, R., McDade, R., Yii, E., McCartney, P., Corcoran, D., Collison, D., Rush, C., Sattar, N., McConnachie, A., Touyz, R. M., Oldroyd, K. G., and Berry, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: JACC: Cardiovascular Interventions
• Publisher: Elsevier
• ISSN: 1936-8798
• ISSN (Online): 1876-7605
• Published Online: 11 November 2019
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in JACC: Cardiovascular Interventions 13(1):33-45
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
190814		BHF centre of excellence	Rhian Touyz	British Heart Foundation (BHF)	RE/13/5/30177	Institute of Cardiovascular & Medical Sciences