Women's IschemiA TRial to Reduce Events In Non-ObstRuctive CAD (WARRIOR): a randomised controlled trial

Area of Science:

• Cardiology
• Women's Health
• Clinical Trials

Background:

• Many women experience angina due to suspected ischemia but have no obstructive coronary artery disease (ANOCA/INOCA).
• This condition significantly impacts quality of life and healthcare resource utilization.

Purpose of the Study:

• To evaluate if intensive medical treatment (IMT) reduces major ischemic events in women with suspected ANOCA/INOCA.
• To compare IMT (high-intensity statin, ACE inhibitor/ARB, aspirin) against usual care (UC).

Main Methods:

• A randomized, prospective, blinded-outcomes evaluation study.
• Conducted across 71 sites in the USA involving 2476 women.
• Primary outcome: composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and hospitalization for angina or heart failure (MACE).

Main Results:

• At 2.5 years, no significant difference in MACE between IMT and UC groups (HR=1.13; p=0.20).
• Hospitalizations for angina were the primary driver of MACE.
• Sensitivity analysis suggested a potential benefit of IMT, but with limited statistical power (HR=0.74; p=0.43).

Conclusions:

• Intensive medical treatment did not improve outcomes in women with suspected ANOCA/INOCA.
• The high burden of angina hospitalizations and reduced quality of life warrants further investigation.
• Limited study power prevents definitive conclusions about the potential efficacy of IMT.