TY - JOUR
T1 - Coronary function testing vs angiography alone to guide treatment of angina with non-obstructive coronary arteries
T2 - the ILIAS ANOCA trial
AU - Boerhout, Coen K M
AU - Namba, Hanae F
AU - Liu, Tommy
AU - Beijk, Marcel A M
AU - Damman, Peter
AU - Meuwissen, Martijn
AU - Ong, Peter
AU - Sechtem, Udo
AU - Appelman, Yolande
AU - Berry, Colin
AU - Escaned, Javier
AU - Lerman, Amir
AU - Henry, Timothy D
AU - van der Harst, Pim
AU - Delewi, Ronak
AU - Piek, Jan J
AU - van de Hoef, Tim P
N1 - Publisher Copyright:
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2025/11
Y1 - 2025/11
N2 - BACKGROUND AND AIMS: Invasive coronary function testing (CFT) identifies coronary vasomotor disorders in up to 90% of patients with angina with non-obstructive coronary arteries (ANOCA). The ILIAS ANOCA trial hypothesized that routine ad hoc CFT would be feasible, safe, and effective in providing an early, comprehensive diagnosis. Additionally, it was anticipated that combining CFT with a disease-specific treatment protocol would significantly improve quality of life in ANOCA patients compared with standard care.METHODS: After excluding patients with obstructive coronary artery disease (CAD) during clinically indicated invasive coronary angiography (ICA), eligible patients underwent CFT and were randomized to either the standard care group, where CFT results remained blinded, or the intervention group, where CFT results were disclosed along with a tailored medical therapy protocol. The primary outcome was the mean difference in the within-subject change in Seattle Angina Questionnaire summary score (SAQSS) between groups from baseline to a follow-up of 6 months. The trial is registered with the International Clinical Trials Registry Platform (NL-OMON20739).RESULTS: A total of 255 patients consented, of whom 153 patients (60%) without CAD underwent CFT and were randomized 1:1 to the standard care (n = 76) or intervention group (n = 77). All CFT procedures were successful without adverse events. A vasomotor disorder was identified in 120 patients (78%). At 6-month follow-up, the SAQSS improved significantly in the intervention group compared with the control group, with an intervention effect of 9.4 units (95% confidence interval 3.9-14.9, P = .001). There were no major adverse cardiac events at the 6-month follow-up.CONCLUSIONS: Routine CFT during the initial ICA was feasible, safe, and had high diagnostic yield. Implementing a pragmatic CFT protocol combined with a disease-specific treatment protocol significantly improved disease-related quality of life in patients with ANOCA compared with standard care.
AB - BACKGROUND AND AIMS: Invasive coronary function testing (CFT) identifies coronary vasomotor disorders in up to 90% of patients with angina with non-obstructive coronary arteries (ANOCA). The ILIAS ANOCA trial hypothesized that routine ad hoc CFT would be feasible, safe, and effective in providing an early, comprehensive diagnosis. Additionally, it was anticipated that combining CFT with a disease-specific treatment protocol would significantly improve quality of life in ANOCA patients compared with standard care.METHODS: After excluding patients with obstructive coronary artery disease (CAD) during clinically indicated invasive coronary angiography (ICA), eligible patients underwent CFT and were randomized to either the standard care group, where CFT results remained blinded, or the intervention group, where CFT results were disclosed along with a tailored medical therapy protocol. The primary outcome was the mean difference in the within-subject change in Seattle Angina Questionnaire summary score (SAQSS) between groups from baseline to a follow-up of 6 months. The trial is registered with the International Clinical Trials Registry Platform (NL-OMON20739).RESULTS: A total of 255 patients consented, of whom 153 patients (60%) without CAD underwent CFT and were randomized 1:1 to the standard care (n = 76) or intervention group (n = 77). All CFT procedures were successful without adverse events. A vasomotor disorder was identified in 120 patients (78%). At 6-month follow-up, the SAQSS improved significantly in the intervention group compared with the control group, with an intervention effect of 9.4 units (95% confidence interval 3.9-14.9, P = .001). There were no major adverse cardiac events at the 6-month follow-up.CONCLUSIONS: Routine CFT during the initial ICA was feasible, safe, and had high diagnostic yield. Implementing a pragmatic CFT protocol combined with a disease-specific treatment protocol significantly improved disease-related quality of life in patients with ANOCA compared with standard care.
KW - Angina with non-obstructive coronary arteries
KW - Coronary function testing
KW - Coronary microvascular dysfunction
KW - Coronary vasospasm
U2 - 10.1093/eurheartj/ehaf580
DO - 10.1093/eurheartj/ehaf580
M3 - Article
C2 - 40796241
SN - 0195-668X
VL - 46
SP - 4396
EP - 4406
JO - European heart journal
JF - European heart journal
IS - 42
M1 - ehaf580
ER -