TOPLINE:
In patients with angina with nonobstructive coronary arteries (ANOCA), routine ad hoc coronary function testing (CFT) during initial invasive angiography combined with a disease-specific treatment identified coronary vasomotor disorders and facilitated the management of angina and quality of life.
METHODOLOGY:
- Researchers reported findings from a prospective trial conducted across five cardiac centers in the Netherlands and Germany to assess the clinical utility of routine ad hoc CFT in patients with ANOCA.
- A total of 153 adults with ANOCA (median age, 64 years; 55% women) underwent CFT during their initial invasive coronary angiography.
- Patients were randomly assigned either to an intervention group, wherein CFT results were disclosed and used to guide tailored treatment, or to a standard care group, wherein CFT results were masked and care followed guideline-based therapy at the cardiologist’s discretion.
- Researchers assessed the impact of angina on quality of life of patients using patient-reported data from the Seattle Angina Questionnaire (SAQ).
- The primary outcome was the mean difference between groups in change in the SAQ summary score from baseline to 6 months of follow-up.
TAKEAWAY:
- CFT procedures were successfully completed in all patients, with a mean procedure time of 21 minutes, and helped identify coronary vasomotor disorders in 78% of patients.
- SAQ summary scores improved more in the intervention group than in the standard care group (mean difference, 9.4 units; P = .001), primarily driven by fewer episodes of angina and better quality of life.
- Patients in the intervention group experienced greater satisfaction with treatment than those in the standard care group (P = .001).
- No CFT-related complications were reported during or immediately after the procedure, and neither group experienced major adverse cardiac events over 6 months of follow-up.
IN PRACTICE:
“Implementing a pragmatic CFT protocol combined with a disease-specific treatment protocol significantly improved disease-related quality of life and angina frequency in patients with ANOCA compared with standard care. These findings support the integration of CFT-guided care into routine clinical practice,” the researchers reported.
SOURCE:
This study was led by Coen K. M. Boerhout of Amsterdam University Medical Center in Amsterdam, the Netherlands. It was published online on August 12, 2025, in the European Heart Journal.
LIMITATIONS:
Conducting a fully blinded randomized study was not possible owing to the nature of CFT. Reliance on patient-reported outcomes may have introduced bias. Defining endotypes of ANOCA according to specific cut-offs may not have captured the full spectrum of the condition.
DISCLOSURES:
This trial was funded by a restricted institutional research grant from Philips to Amsterdam University Medical Center. Several authors reported receiving consultancy fees, speaker fees, honoraria, and institutional research grants from various sources, including Philips, British Heart Foundation, and Medical Research Council. One author reported being an employee of the University of Glasgow, which holds financial ties with multiple pharmaceutical and healthcare companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.