One-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA)

Abstract

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.