Trial reportHeart (British Cardiac Society)2025
Coronary microvascular function and atherosclerotic plaque burden in ischaemia and no obstructive coronary arteries: a secondary analysis of the CorMicA trial.
Trial report in Heart (British Cardiac Society), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed.
- PET-based assessment of coronary microvascular dysfunction and its relation to plaque burden and vascular remodeling: integration with microvascular resistance reserve.European journal of nuclear medicine and molecular imaging · 2026Article
- Evolving Beyond Anatomy: The Synergistic Role of Baseline Physiology and Optimal Hemodynamics in Relieving Angina.JACC. Asia · 2026Article
- Inoca and Its Diagnosis by Microvascular Study, A Case Report.Reports (MDPI) · 2026Article
- Artificial intelligence-enabled plaque characterization from coronary computed tomography establishes basis of angina in women with nonobstructive atherosclerosis.Communications medicine · 2026Article
- Vessel-specific perivascular fat attenuation index derived from AI-CCTA and its association with impaired coronary flow reserve in patients with INOCA.International journal of cardiology. Heart & vasculature · 2026Article
- Assessing myocardial microcirculation in post-PCI patients with chest pain and anxiety: a dynamic CT myocardial perfusion study with mental stress testing.BMC medical imaging · 2026Article
Corrections and comments
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Authors and funding
22 authors.
Funding
Abstract
backgroundThe relationship between atherosclerosis and endotypes of myocardial ischaemia with no obstructive coronary artery disease (INOCA) is unclear. We investigated potential associations between cumulative atherosclerotic plaque burden quantified using the Gensini score, novel invasive indices of coronary microvascular function (microvascular resistance reserve (MRR); resistive reserve ratio (RRR)) and related INOCA endotypes.
methodsCoronary angiography and invasive coronary function tests were simultaneously acquired in the CorMicA cohort. A comprehensive physiological assessment was performed using both a thermodilution-based diagnostic guidewire and intracoronary acetylcholine provocation testing. Angiograms were examined for luminal stenosis in each segment of the SYNTAX coronary model. Cumulative plaque burden was quantified using the Gensini score, which incorporated both the number of diseased coronary segments and stenosis severity. Results were compared with indices of microvascular function and INOCA endotypes. Angiographic analyses were performed blind to coronary physiology findings.
resultsIn 151 participants (median age 61 years; 73.5% female) without flow-limiting coronary artery disease, medical history included 41.7% smoking, 63.6% hypertension and 19.2% diabetes mellitus. The left anterior descending artery underwent diagnostic guidewire testing in 85.4%, and 55.0% of participants had abnormal coronary flow reserve (CFR) and/or Index of Microcirculatory Resistance (IMR). The median Gensini score was 6.0 (IQR 2.5-11.0). CFR (p=0.012), MRR (p=0.026) and RRR (p=0.026), but not IMR (p=0.445), were univariably associated with raised Gensini scores. These significant effects persisted in multivariable models controlling for potential confounders. Considering INOCA endotypes, Gensini scores differed among participants with microvascular angina (MVA) (7.0 (2.5-11.0)), vasospastic angina (VSA) (4.5 (2.0-10.0)), mixed MVA/VSA (9.0 (5.0-11.5)) and non-cardiac symptoms (3.5 (1.5-8.0)); Kruskal-Wallis p=0.030.
conclusionsReduced CFR, MRR and RRR, and MVA were associated with increased coronary atherosclerotic plaque burden, as evidenced by higher Gensini scores. These novel findings provide a mechanistic link between INOCA and cardiovascular events, reinforcing the importance of antiatherosclerosis therapy in patients with MVA.
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