Endotypes of angina with non-obstructive coronary arteries: a prospective multicentre study
Authors' conclusion
In patients with suspected ANOCA, assessment of the symptomatic, electrocardiographic, and haemodynamic responses to adenosine and acetylcholine identifies distinct endotypes and enables mechanism-guided stratified medicine.
Study context
- Population
- Consecutive patients with angina (or equivalent), no angiographically severe stenosis and FFR > 0.80 undergoing coronary functional testing, 9 centres in Europe and North America
- Participants
- 1,001 patients
- Outcome
- Haemodynamic endotypes (adenosine and acetylcholine testing)
Methodological detailsmulticentre, consecutive enrolment, Delphi consensus
- Multicentre
- Consecutive enrolment
- Delphi consensus
Main finding
As reported in the abstract
- High resting coronary blood flow
- n = 195, 19%
- High resistance
- n = 125, 13%
- Compensated high resistance
- n = 112, 11%
- Epicardial coronary spasm
- n = 162, 17%
- Microvascular spasm
- n = 75, 8%
- Endothelial dysfunction
- n = 96, 10%
- Ischaemia w/o haemodynamic changes
- n = 68, 7%
- Enhanced cardiac nociception
- n = 79, 8%
- More than one endotype
- 119 (12%)
- Normal responses
- 234 (23%)
Observational data: associations, not effects.
Further findings
Delphi consensus on endotype-specific therapy
- Endotype-specific medical therapy identified with Likert score ≥ 6 for all endotypes (100% 'agree' or 'strongly agree')
Clinical correlates
- Each endotype associated with distinct clinical correlates
Original publication
Endotypes of angina with non-obstructive coronary arteries: a prospective multicentre study. Eur Heart J. Published 11 November 2025. doi:10.
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