Endotype-guided medical therapy and symptom response in ANOCA.
J, F., S, K., G, C., S, B., A, S., J, L.S., V, P., G, M., BC, C., & AM, L. (2026). Endotype-guided medical therapy and symptom response in ANOCA.. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Card. https://doi.org/10.4244/EIJ-D-26-00148
J F, S K, G C, S B, A S, J LS, et al. Endotype-guided medical therapy and symptom response in ANOCA.. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Card. 2026; doi: 10.4244/EIJ-D-26-00148
J F, S K, G C, et al. Endotype-guided medical therapy and symptom response in ANOCA.[J]. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Card. 2026. DOI: 10.4244/EIJ-D-26-00148.
@article{j2026,
author = {Farina J and Kumar S and Campo G and Biscaglia S and Sarti A and Llevadot-Sesmilo J and Paradies V and Mincione G and Case BC and Leone AM},
title = {Endotype-guided medical therapy and symptom response in ANOCA.},
journal = {EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Card},
year = {2026},
doi = {10.4244/EIJ-D-26-00148},
note = {PMID: 42473746},
}
TY - JOUR AU - Farina J AU - Kumar S AU - Campo G AU - Biscaglia S AU - Sarti A AU - Llevadot-Sesmilo J AU - Paradies V AU - Mincione G AU - Case BC AU - Leone AM TI - Endotype-guided medical therapy and symptom response in ANOCA. T2 - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Card PY - 2026 DO - 10.4244/EIJ-D-26-00148 AN - PMID:42473746 ER -
BACKGROUND: Invasive coronary functional testing enables the classification of angina with non-obstructive coronary arteries (ANOCA) into distinct endotypes. However, real-world data linking endotype identification to subsequent pharmacological management and patient-reported symptom outcomes remain limited. AIMS: We sought to evaluate the association between coronary endotypes, post-testing pharmacological treatment patterns, and changes in angina-related quality of life in patients with ANOCA in a multicentre real-world registry. METHODS: Consecutive ANOCA patients undergoing invasive coronary functional testing were included. Patients were classified into six endotypes using adenosine- and acetylcholine-based testing. Pharmacological therapy was adjusted at the discretion of the treating physician based on the functional test results. The primary endpoint was a 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. RESULTS: Among 525 patients, endotype distribution was as follows: normal physiology 10.5%, elevated resting coronary blood flow 8.8%, high resistance 13.9%, compensated high resistance 14.9%, epicardial spasm 33.3%, and microvascular spasm 18.7%. After testing, prescription patterns differed across the endotypes, with increased use of beta blockers, ranolazine, and renin-angiotensin-aldosterone system blockers in coronary microvascular dysfunction endotypes and greater use of non-dihydropyridine calcium channel blockers in vasospastic endotypes. At follow-up, a ΔSAQ-7 summary score ≥5 points was observed in elevated resting flow, high-resistance, compensated high-resistance, and epicardial spasm endotypes (all p<0.001) but not in microvascular spasm or normal physiology. CONCLUSIONS: 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.