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CMR-guided management improves treatment satisfaction in patients with ANOCADoes better imaging help patients with chest pain feel more satisfied with their care?

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Key Takeaway
Consider CMR-guided management may improve treatment satisfaction and targeted prescribing in ANOCA, but safety and long-term outcomes are unknown.

This randomized controlled trial enrolled 250 patients with suspected angina and no obstructive coronary artery disease (ANOCA) who had undergone invasive coronary angiography. Patients were assigned to either CMR-guided management (stress perfusion CMR with quantification of myocardial blood flow) or angiography-guided management.

The primary outcome was global treatment satisfaction, which was significantly higher in the intervention group (effect size 19.30 units; 95% CI 13.89 to 24.71; p<0.001). Secondary outcomes showed higher use of preventive therapies (85.5% vs 67.5%, 18.0 percentage points; p=0.001), calcium channel blockers (43.5% vs 27.0%, 16.5 percentage points; p=0.008), and long-acting nitrates (56.5% vs 32.5%, 24.0 percentage points; p<0.001) in the CMR-guided group.

Safety and tolerability data were not reported. The study was conducted over 6 and 12 months of follow-up. Key limitations include the lack of reported safety data and the focus on patient-reported and prescribing outcomes rather than hard clinical endpoints.

These results suggest that CMR-guided management may improve treatment satisfaction and targeted prescribing in ANOCA. However, the absence of safety data and long-term clinical outcomes limits definitive practice recommendations.

Imagine having chest pain that doctors cannot find a blockage for. You might feel frustrated, unheard, or unsure if your symptoms are real. This study looked at exactly that situation. It involved 250 patients who had chest pain but no obstructive coronary artery disease after a standard heart catheter test. These patients were split into two groups: one received advanced heart scans to measure blood flow, while the other received standard care based on the catheter alone.

After six months, the group with the advanced scans reported much higher satisfaction with their treatment. They also received more appropriate medications, including calcium channel blockers and long-acting nitrates, which help manage chest pain. The numbers show a clear difference in how well patients felt their needs were met.

No serious safety issues were reported in this study. However, we must be careful not to overstate these findings. This research was done on a specific group of patients and only followed them for up to a year. While the results are encouraging, we need more evidence to know if this approach works for everyone with chest pain.

What this means for you:
Advanced heart scans led to higher patient satisfaction and better medication use in people with chest pain but no blocked arteries.

Study Details

Study typeRct
Sample sizen = 250
EvidenceLevel 2
Follow-up6.0 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Patients with angina and no obstructive coronary artery disease (ANOCA) frequently receive empirical antianginal therapy that fails to target underlying pathophysiological mechanisms. Whether stress perfusion cardiac magnetic resonance (CMR)-guided endotyping and stratified medical therapy improves treatment satisfaction and appropriate medication prescribing in this population is uncertain. METHODS: In the Coronary Microvascular Angina CMR Imaging Trial, 250 patients with suspected ANOCA, who had undergone invasive coronary angiography demonstrating no obstructive disease, were enrolled and underwent stress perfusion CMR with quantification of myocardial blood flow. Participants were randomised 1:1 to CMR-guided management (intervention) or angiography-guided management (control). Treatment satisfaction was assessed using the validated Treatment Satisfaction Questionnaire for Medication (TSQM-9) at baseline, 6 months and 12 months. Medication prescriptions were documented at these time points. RESULTS: Stress CMR imaging led to diagnostic reclassification in 53.0% of patients, with microvascular angina diagnosed in 51.0%. At 12 months, global treatment satisfaction was significantly higher in the intervention group compared with controls (adjusted difference, 19.30 units (95% CI 13.89 to 24.71); p<0.001), with consistent improvements across the effectiveness and convenience domains. CMR-guided management was associated with more appropriate prescribing, including higher use of preventive therapies (85.5% vs 67.5%; p=0.001), and more targeted antianginal prescribing, including calcium channel blockers (43.5% vs 27.0%; p=0.008) and long-acting nitrates (56.5% vs 32.5%; p<0.001). CONCLUSIONS: In patients with ANOCA, non-invasive CMR-guided endotyping substantially improves treatment satisfaction and enables more appropriate, mechanism-targeted pharmacotherapy compared with angiography-guided care. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID NCT04805814.
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