Key result
CorCTCA evaluates whether endotype-stratified therapy improves angina scores in INOCA patients.
Why the study?
Microvascular and vasospastic anginas are relevant causes of ischemia with no obstructive coronary artery disease (INOCA) after CT coronary angiography, but the prevalence of disease endotypes and the clinical value of stratified medicine in this population are not well characterized.
Does therapy stratified by invasive disease endotype improve Seattle Angina Questionnaire scores at 6 months in patients with INOCA?
RCT
blinded, sham-controlled
1:1
Yes
Does therapy stratified by invasive disease endotype improve Seattle Angina Questionnaire scores at 6 months in patients with INOCA?
The CorCTCA study is designed to evaluate whether stratifying therapy by invasive disease endotype improves angina symptoms in patients with INOCA.
Nested RCT will test stratified therapy for INOCA; leaves open whether diagnosis-guided treatment improves outcomes.
Microvascular and/or vasospastic anginas are relevant causes of ischemia with no obstructive coronary artery disease (INOCA) in patients after computed tomography coronary angiography (CTCA). OBJECTIVES: Our research has 2 objectives. The first is to undertake a diagnostic study, and the second is to undertake a nested, clinical trial of stratified medicine. DESIGN: A prospective, multicenter, randomized, blinded, sham-controlled trial of stratified medicine (NCT03477890) will be performed. All-comers referred for clinically indicated CTCA for investigation of suspected coronary artery disease (CAD) will be screened in 3 regional centers. Following informed consent, eligible patients with angina symptoms are enrolled before CTCA and remain eligible if CTCA excludes obstructive CAD. Diagnostic study: Invasive coronary angiography involving an interventional diagnostic procedure (IDP) to assess for disease endotypes: (1) angina due to obstructive CAD (fractional flow reserve ≤0.80); (2) microvascular angina (coronary flow reserve <2.0 and/or index of microvascular resistance >25); (3) microvascular angina due to small vessel spasm (acetylcholine); (4) vasospastic angina due to epicardial coronary spasm (acetylcholine); and (5) noncoronary etiology (normal coronary function). The IDP involves direct invasive measurements using a diagnostic coronary guidewire followed by provocation testing with intracoronary acetylcholine. The primary outcome of the diagnostic study is the reclassification of the initial CTCA diagnosis based on the IDP. Stratified medicine trial: Participants are immediately randomized 1:1 in the catheter laboratory to therapy stratified by endotype (intervention group) or not (control group). The primary outcome of the trial is the mean within-subject change in Seattle Angina Questionnaire score at 6 months. Secondary outcomes include safety, feasibility, diagnostic utility (impact on diagnosis and certainty), and clinical utility (impact on treatment and investigations). Health status assessments include quality of life, illness perception, anxiety-depression score, treatment satisfaction, and physical activity. Participants who are not randomized will enter a follow-up registry. Health and economic outcomes in the longer term will be assessed using electronic patient record linkage. VALUE: CorCTCA will prospectively characterize the prevalence of disease endotypes in INOCA and determine the clinical value of stratified medicine in this population.
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Sidik et al. (2019) conducted an RCT in Ischemia with no obstructive coronary artery disease (INOCA). Therapy stratified by endotype vs. Control group (therapy not stratified by endotype) was evaluated on Mean within-subject change in Seattle Angina Questionnaire score at 6 months. The CorCTCA study is a randomized, sham-controlled trial designed to evaluate whether therapy stratified by disease endotype improves Seattle Angina Questionnaire scores at 6 months in INOCA patients.
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