Cargando…
1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA)
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 funct...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310942/ https://www.ncbi.nlm.nih.gov/pubmed/31709984 http://dx.doi.org/10.1016/j.jcin.2019.11.001 |
_version_ | 1783728857830916096 |
---|---|
author | Ford, Thomas J. Stanley, Bethany Sidik, Novalia Good, Richard Rocchiccioli, Paul McEntegart, Margaret Watkins, Stuart Eteiba, Hany Shaukat, Aadil Lindsay, Mitchell Robertson, Keith Hood, Stuart McGeoch, Ross McDade, Robert Yii, Eric McCartney, Peter Corcoran, David Collison, Damien Rush, Christopher Sattar, Naveed McConnachie, Alex Touyz, Rhian M. Oldroyd, Keith G. Berry, Colin |
author_facet | Ford, Thomas J. Stanley, Bethany Sidik, Novalia Good, Richard Rocchiccioli, Paul McEntegart, Margaret Watkins, Stuart Eteiba, Hany Shaukat, Aadil Lindsay, Mitchell Robertson, Keith Hood, Stuart McGeoch, Ross McDade, Robert Yii, Eric McCartney, Peter Corcoran, David Collison, Damien Rush, Christopher Sattar, Naveed McConnachie, Alex Touyz, Rhian M. Oldroyd, Keith G. Berry, Colin |
author_sort | Ford, Thomas J. |
collection | PubMed |
description | 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) |
format | Online Article Text |
id | pubmed-8310942 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-83109422021-07-28 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA) Ford, Thomas J. Stanley, Bethany Sidik, Novalia Good, Richard Rocchiccioli, Paul McEntegart, Margaret Watkins, Stuart Eteiba, Hany Shaukat, Aadil Lindsay, Mitchell Robertson, Keith Hood, Stuart McGeoch, Ross McDade, Robert Yii, Eric McCartney, Peter Corcoran, David Collison, Damien Rush, Christopher Sattar, Naveed McConnachie, Alex Touyz, Rhian M. Oldroyd, Keith G. Berry, Colin JACC Cardiovasc Interv Coronary 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) Elsevier 2020-01-13 /pmc/articles/PMC8310942/ /pubmed/31709984 http://dx.doi.org/10.1016/j.jcin.2019.11.001 Text en © 2020 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Coronary Ford, Thomas J. Stanley, Bethany Sidik, Novalia Good, Richard Rocchiccioli, Paul McEntegart, Margaret Watkins, Stuart Eteiba, Hany Shaukat, Aadil Lindsay, Mitchell Robertson, Keith Hood, Stuart McGeoch, Ross McDade, Robert Yii, Eric McCartney, Peter Corcoran, David Collison, Damien Rush, Christopher Sattar, Naveed McConnachie, Alex Touyz, Rhian M. Oldroyd, Keith G. Berry, Colin 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA) |
title | 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA) |
title_full | 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA) |
title_fullStr | 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA) |
title_full_unstemmed | 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA) |
title_short | 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA) |
title_sort | 1-year outcomes of angina management guided by invasive coronary function testing (cormica) |
topic | Coronary |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310942/ https://www.ncbi.nlm.nih.gov/pubmed/31709984 http://dx.doi.org/10.1016/j.jcin.2019.11.001 |
work_keys_str_mv | AT fordthomasj 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT stanleybethany 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT sidiknovalia 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT goodrichard 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT rocchicciolipaul 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT mcentegartmargaret 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT watkinsstuart 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT eteibahany 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT shaukataadil 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT lindsaymitchell 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT robertsonkeith 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT hoodstuart 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT mcgeochross 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT mcdaderobert 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT yiieric 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT mccartneypeter 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT corcorandavid 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT collisondamien 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT rushchristopher 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT sattarnaveed 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT mcconnachiealex 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT touyzrhianm 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT oldroydkeithg 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica AT berrycolin 1yearoutcomesofanginamanagementguidedbyinvasivecoronaryfunctiontestingcormica |