EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2026
Endotype-guided medical therapy and symptom response in ANOCA.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Farina Jacopo, Kumar Sant, Campo Gianluca, Biscaglia Simone, Sarti Alberto, Llevadot-Sesmilo Joan, Paradies Valeria, Mincione Gianluca, Case Brian Christopher, Leone Antonio Maria, Galante Domenico, Erriquez Andrea, Brugaletta Salvatore
Аннотация
BACKGROUND: Invasive coronary functional testing enables the classification of angina with non-obstructive coronary arteries (ANOCA) into distinct endotypes. However, real-world data linking endotype identification to subsequent pharmacological management and patient-reported symptom outcomes remain limited.
AIMS: We sought to evaluate the association between coronary endotypes, post-testing pharmacological treatment patterns, and changes in angina-related quality of life in patients with ANOCA in a multicentre real-world registry.
METHODS: Consecutive ANOCA patients undergoing invasive coronary functional testing were included. Patients were classified into six endotypes using adenosine- and acetylcholine-based testing. Pharmacological therapy was adjusted at the discretion of the treating physician based on the functional test results. The primary endpoint was a clinically meaningful improvement in angina-related health status, defined as a ≥5-point increase in the 7-item Seattle Angina Questionnaire (SAQ-7) summary score, assessed within each endotype.
RESULTS: Among 525 patients, endotype distribution was as follows: normal physiology 10.5%, elevated resting coronary blood flow 8.8%, high resistance 13.9%, compensated high resistance 14.9%, epicardial spasm 33.3%, and microvascular spasm 18.7%. After testing, prescription patterns differed across the endotypes, with increased use of beta blockers, ranolazine, and renin-angiotensin-aldosterone system blockers in coronary microvascular dysfunction endotypes and greater use of non-dihydropyridine calcium channel blockers in vasospastic endotypes. At follow-up, a ΔSAQ-7 summary score ≥5 points was observed in elevated resting flow, high-resistance, compensated high-resistance, and epicardial spasm endotypes (all p<0.001) but not in microvascular spasm or normal physiology.
CONCLUSIONS: In this multicentre real-world registry, invasive coronary endotyping was associated with distinct pharmacological management patterns and differential changes in angina-related quality of life across ANOCA endotypes.
AIMS: We sought to evaluate the association between coronary endotypes, post-testing pharmacological treatment patterns, and changes in angina-related quality of life in patients with ANOCA in a multicentre real-world registry.
METHODS: Consecutive ANOCA patients undergoing invasive coronary functional testing were included. Patients were classified into six endotypes using adenosine- and acetylcholine-based testing. Pharmacological therapy was adjusted at the discretion of the treating physician based on the functional test results. The primary endpoint was a clinically meaningful improvement in angina-related health status, defined as a ≥5-point increase in the 7-item Seattle Angina Questionnaire (SAQ-7) summary score, assessed within each endotype.
RESULTS: Among 525 patients, endotype distribution was as follows: normal physiology 10.5%, elevated resting coronary blood flow 8.8%, high resistance 13.9%, compensated high resistance 14.9%, epicardial spasm 33.3%, and microvascular spasm 18.7%. After testing, prescription patterns differed across the endotypes, with increased use of beta blockers, ranolazine, and renin-angiotensin-aldosterone system blockers in coronary microvascular dysfunction endotypes and greater use of non-dihydropyridine calcium channel blockers in vasospastic endotypes. At follow-up, a ΔSAQ-7 summary score ≥5 points was observed in elevated resting flow, high-resistance, compensated high-resistance, and epicardial spasm endotypes (all p<0.001) but not in microvascular spasm or normal physiology.
CONCLUSIONS: In this multicentre real-world registry, invasive coronary endotyping was associated with distinct pharmacological management patterns and differential changes in angina-related quality of life across ANOCA endotypes.