Coronary disease & ACSCohort study
Endotype-guided medical therapy and symptom response in angina with non-obstructive coronary arteries (ANOCA)
- multicentre real-world registry
- Consecutive ANOCA patients
Authors' conclusion
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.
Study context
- Population
- Patients with angina with non-obstructive coronary arteries (ANOCA) undergoing invasive coronary functional testing
- Participants
- 525 patients
- Exposure
- association between coronary endotypes, post-testing pharmacological treatment patterns, and changes in angina-related quality of life
- Outcome
- 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
- Follow-up
- follow-up
Main finding
As reported in the abstract
ΔSAQ-7 summary score ≥5 points observed in elevated resting flow, high-resistance, compensated high-resistance, and epicardial spasm endotypes
all p<0.001
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| Endotype distribution | normal physiology 10.5% · elevated resting coronary blood flow 8.8% · high resistance 13.9% · compensated high resistance 14.9% · epicardial spasm 33.3% · microvascular spasm 18.7% |
Prescription patterns after testing
- increased use of beta blockers, ranolazine, and renin-angiotensin-aldosterone system blockers in coronary microvascular dysfunction endotypes
- greater use of non-dihydropyridine calcium channel blockers in vasospastic endotypes
Original publication
Endotype-guided medical therapy and symptom response in ANOCA. EuroIntervention. Published 20 July 2026. doi:10.4244/eij-d-26-00148
Summarised from the published abstract; every number is checked against it