(Long-term) efficacy of endotype-based drug therapy on quality of life and symptom management in coronary vasomotion disorders.

BACKGROUND

In patients with angina despite non-obstructive coronary arteries (ANOCA), coronary vasomotion disorders (CVD) are a common cause for their symptoms. Due to the heterogeneous clinical presentation resulting from a broad spectrum of endotypes, symptom management still remains a major challenge. We aimed to demonstrate that endotype-based pharmacotherapy can improve angina severity and quality of life (QoL) outcomes in these patients.

METHODS

Between 04/2021-02/2022 we enrolled 50 ANOCA-patients (56% women, 63 ± 14 years) with confirmed diagnosis of CVD (coronary spasm: n = 30; microvascular vasodilatation disorder: n = 3; combined endotype: n = 17). All patients received an individual endotype-adapted antianginal pharmacotherapy. Efficacy and tolerability were closely monitored and adjusted during a 3-month follow-up period, accompanied by a symptom diary which served as a patient-reported outcome measure (PROM). QoL was assessed using the Seattle Angina Questionnaire-7 (SAQ7) monthly during the 3-month therapy adjustment and at long-term follow-up after 3 years.

RESULTS

After targeted pharmacotherapy for 3 months, 70% of patients showed a clinically relevant improvement in the SAQ7-Summary score (62 ± 22 from 47 ± 18; p < 0.001). PROM-scores showed a significant decrease in monthly number of chest pain attacks by 38% (p = 0.041) and nitroglycerine intake by 67% (p = 0.004) accompanied by a significant PROM mood-score improvement (0.5 points within a 1-5 scale; p < 0.001). Long-term follow-up after 3 years (n = 40) revealed that 81% of the patients with isolated coronary spasm or vasodilation disorder benefited sustainably from endotype-based therapy with an improved SAQ7-Summary score.

CONCLUSION

Endotype-based pharmacotherapy can contribute decisively to long-term symptom and QoL improvement, particularly in ANOCA-patients with isolated endotypes.