What is the clinical evidence from this study?

Study design: Observational. Population: Ischemia and no obstructive coronary arteries (INOCA) (n=71). Intervention: Coronary function testing (CFT). Primary outcome: Changes in medication use after coronary function testing (P = .008, p=.008).

What does this research mean for the field?

Coronary function testing (CFT) is feasible and positively impacts medication management in patients with ischemia and no obstructive coronary arteries (INOCA). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This research aims to evaluate the feasibility of coronary function testing (CFT) and its influence on medication management in patients with ischemia and no obstructive coronary arteries.

March 13, 2026Open Access

Feasibility and Impact of Invasive Coronary Function Testing in Ischemia and No Obstructive Coronary Arteries: A Single-Center Study

Key Result

Coronary function testing significantly increased the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers from 39.5% to 55.8% in patients with coronary microvascular disease at 30 days post-procedure.

Key Points

This research aims to evaluate the feasibility of coronary function testing (CFT) and its influence on medication management in patients with ischemia and no obstructive coronary arteries.
Single-center, prospective study conducted from 2020 to 2025.
Evaluated CFT implementation and subsequent medication adjustments in patients.
Interventional cardiologists rated CFT feasibility and diagnostic value through surveys.
Patient outcomes categorized by coronary microvascular disease, vasospastic angina, mixed disease, and no vasomotor diagnosis.
Compared medication use at baseline and 30 days post-CFT.
98% of interventional cardiologists rated CFT preparation and diagnostic value as above average.
Among 71 patients, 60.6% were diagnosed with coronary microvascular disease and 26.8% with vasospastic angina.
Medication use significantly increased for angiotensin converting enzyme inhibitors and statins in CMD patients.
Adverse events were low, with 90% of reported events being self-limited.

Study Design

Type

Observational (n=71)

Multicenter

Structured PICO

Does invasive coronary function testing impact medication management in patients with suspected ischemia and no obstructive coronary arteries?

Population

71 patients with suspected ischemia and no obstructive coronary arteries (INOCA) defined as <50% stenosis on coronary angiography, mean age 56.6, 71.8% women.

Intervention

Invasive coronary function testing (CFT) with adenosine and acetylcholine to identify INOCA endotypes (coronary microvascular disease, vasospastic angina, mixed disease, or no vasomotor diagnosis) to guide medical therapy.

Comparator

Baseline medication use prior to coronary function testing.

Outcome

Feasibility of CFT (assessed via interventionalist surveys, procedural time, and adverse events) and impact on medication management at 30 days post-CFT.

Invasive coronary function testing is feasible, safe, and leads to targeted medication changes in patients with suspected ischemia and no obstructive coronary arteries.

Main Result

Effect estimate: P = .008

Absolute Event Rate: 55.8% vs 39.5%

p-value: p=.008

Abstract

Background:In patients with suspected ischemia and no obstructive coronary arteries (INOCA), coronary function testing (CFT) helps identify underlying endotypes.Despite guideline support, adoption of CFT remains limited.This study assessed the feasibility of CFT and its impact on medical management.Methods: This single-center, prospective study (2020-2025) evaluated CFT implementation and subsequent medication changes in patients with clinically indicated CFT.Interventional cardiologists completed postprocedure surveys rating CFT feasibility, preparation, lab support, and diagnostic value.CFT results were categorized into coronary microvascular disease (CMD), (coronary flow reserve 75% epicardial constriction), or (2) microvascular VA (<75% epicardial constriction); mixed disease (MD) (CMD and VA), and no vasomotor diagnosis (no CMD or VA).Medication use was compared at baseline and 30 days after CFT.Results: Five of the 10 interventional cardiologists completed 71 surveys.Overall, 98% rated preparation, training, procedural ease, and diagnostic value as "above average" and would recommend CFT to peers.Mean procedural time was 19 minutes, 7 seconds.There were 10 (14%) adverse events, of which 90% were self-limited.Among 71 patients, 60.6% had CMD, 26.8% VA, and 22.5% MD.CMD patients showed increased angiotensin converting enzyme inhibitor/angiotensin receptor blocker use (39.5% to 55.8%, P = .008)and statin use (53.5% to 65.1%, P = .02).VA patients had increased calcium channel blocker use (68.4% to 89.5%, P = .10).MD and no vasomotor diagnosis had no significant medication changes.Conclusions: CFT was rated highly for feasibility, safety, and clinical value by the interventional cardiologists.CFT appeared to impact the medication management of INOCA endotypes.

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Cite This Study

Acharya et al. (Sun,) conducted a observational in Ischemia and no obstructive coronary arteries (INOCA) (n=71). Coronary function testing (CFT) was evaluated on Changes in medication use after coronary function testing (P = .008, p=.008). Coronary function testing significantly increased the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers from 39.5% to 55.8% in patients with coronary microvascular disease at 30 days post-procedure.

synapsesocial.com/papers/69b3ab3c02a1e69014ccbe1d https://doi.org/https://doi.org/10.1016/j.jscai.2026.104272

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