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Updated: Jan 4, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA)
Thomas J Ford1, Bethany Stanley2, Novalia Sidik3
1West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; Gosford Hospital, NSW Health, Gosford, Australia.
Insights
Invasive coronary function testing improved angina symptoms and quality of life for patients without obstructive coronary artery disease. This stratified medical therapy approach showed sustained benefits at one year.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Procedures
Background:
- Angina management in patients without obstructive coronary artery disease (CAD) is challenging.
- Invasive coronary function testing (ICFT) offers potential for personalized medical therapy.
- Long-term outcomes of ICFT-guided management in this population remain under investigation.
Purpose of the Study:
- To evaluate the effectiveness of ICFT in stratifying management for angina patients without obstructive CAD.
- To assess the impact of ICFT-guided therapy on patient-reported outcomes and clinical events.
Main Methods:
- 151 patients with angina and ischemia but no obstructive CAD were randomized.
- Intervention group received stratified medical therapy guided by ICFT.
- Control group received standard care with blinded ICFT results.
- Primary endpoints included 1-year Seattle Angina Questionnaire and EQ-5D scores, and major adverse cardiac events.
Main Results:
- The intervention group showed a significant improvement in overall angina symptoms (27% increase in SAQ score) at 1 year (p<0.001).
- Quality of life (EQ-5D index) significantly improved in the intervention group compared to controls (mean difference 0.11 units, p=0.010).
- Major adverse cardiac events were similar between groups after a median 19-month follow-up (12% vs 11%, p=0.803).
Conclusions:
- Stratified medical therapy guided by ICFT significantly improves angina symptoms and quality of life in patients with ischemia and no obstructive CAD.
- These benefits are sustained at one year post-procedure.
- ICFT facilitates effective management strategies for this patient cohort.
Objectives:
The aim of this study was to test the hypothesis that invasive coronary function testing at time of angiography could help stratify management of angina patients without obstructive coronary artery disease.
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:
A total of 151 patients with angina with symptoms and/or signs of ischemia and no obstructive coronary artery disease were randomized to stratified medical therapy guided by an interventional diagnostic procedure versus standard care (control group with blinded interventional diagnostic procedure results). The interventional diagnostic procedure-facilitated diagnosis (microvascular angina, vasospastic angina, both, or neither) was linked to guideline-based management. Pre-specified endpoints included 1-year patient-reported outcome measures (Seattle Angina Questionnaire, quality of life [EQ-5D]) and major adverse cardiac events (all-cause mortality, myocardial infarction, unstable angina hospitalization or revascularization, heart failure hospitalization, and cerebrovascular event) at subsequent follow-up.
Results:
Between November 2016 and December 2017, 151 patients with ischemia and no obstructive coronary artery disease were randomized (n = 75 to the intervention group, n = 76 to the control group). At 1 year, overall angina (Seattle Angina Questionnaire summary score) improved in the intervention group by 27% (difference 13.6 units; 95% confidence interval: 7.3 to 19.9; p < 0.001). Quality of life (EQ-5D index) improved in the intervention group relative to the control group (mean difference 0.11 units [18%]; 95% confidence interval: 0.03 to 0.19; p = 0.010). After a median follow-up duration of 19 months (interquartile range: 16 to 22 months), major adverse cardiac events were similar between the groups, occurring in 9 subjects (12%) in the intervention group and 8 (11%) in the control group (p = 0.803).
Conclusions:
Stratified medical therapy in patients with ischemia and no obstructive coronary artery disease leads to marked and sustained angina improvement and better quality of life at 1 year following invasive coronary angiography. (Coronary Microvascular Angina [CorMicA]; NCT03193294).
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