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A Multidomain Lifestyle Intervention for Invasively Confirmed ANOCA: The SAMCRO Randomized Trial
Serena Caglioni1, Andrea Raisi2, Andrea Erriquez1
1Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy.
JACC. Cardiovascular Interventions
|July 27, 2026
Summary
A structured multidomain lifestyle intervention significantly improved health status and quality of life for patients with angina with no obstructive coronary artery disease (ANOCA). This approach, integrating exercise, diet, and psychological support, offers meaningful benefits beyond standard medical therapy.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Trials
Background:
- Angina with no obstructive coronary artery disease (ANOCA) presents persistent symptoms and reduced quality of life.
- Current guidelines recommend a patient-centered, multidisciplinary approach for ANOCA management.
- However, robust randomized evidence supporting such interventions is limited.
Purpose of the Study:
- To evaluate the efficacy of a structured multidomain lifestyle intervention in improving patient-reported health status and quality of life in ANOCA patients.
- To compare the outcomes of endotype-guided therapy plus lifestyle intervention versus endotype-guided therapy alone.
Main Methods:
- The Standardizing the Management of Patients With Coronary Microvascular Dysfunction (SAMCRO) trial was a prospective, multicenter, randomized study.
- Patients with ANOCA were randomized to receive either endotype-guided therapy plus a multidomain lifestyle intervention or endotype-guided therapy alone.
- The intervention included exercise training, Mediterranean diet counseling, and psychological support, with the primary endpoint being the change in Seattle Angina Questionnaire summary score at 12 months.
Main Results:
- A total of 123 patients were randomized, with 12-month follow-up data available for the primary endpoint.
- The intervention group showed a significantly greater improvement in the Seattle Angina Questionnaire summary score compared to the control group (13.12 points difference, P < 0.001).
- A clinically meaningful improvement (≥10 points) was achieved by 77% of patients in the intervention group versus 38% in the control group (adjusted RR: 1.98, P < 0.001), with additional benefits in quality of life and depression scores.
Conclusions:
- A structured multidomain lifestyle intervention significantly enhances patient-reported health status in ANOCA patients.
- This intervention provides clinically meaningful improvements in quality of life and symptom burden.
- The findings support integrating comprehensive lifestyle interventions into the management of ANOCA on top of endotype-guided medical therapy.
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