Tailored treatment of specific diagnosis improves symptoms and quality of life in patients with myocardial Ischemia and Non-obstructive Coronary Arteries
Bibliographic record
Abstract
Ischemia and non-obstructive coronary arteries (INOCA) represents a challenging clinical scenario affecting a considerable proportion of patients undergoing coronary angiography. INOCA manifests with various pathomechanisms, including abnormalities in coronary microvessels and vasomotor disorders. INOCA patients experience substantial symptoms and heightened risk of adverse cardiac events. Guidelines outline diagnostic and treatment strategies, emphasizing tailored approaches for improved outcomes. This study aimed to evaluate symptoms and quality of life changes in INOCA patients following tailored treatment based on comprehensive diagnostic assessment of the coronary circulation. This is a single-center prospective registry of symptomatic adult patients diagnosed with INOCA. Comprehensive invasive physiological diagnostics including assessment of coronary microcirculation function and coronary artery reactivity were conducted. Clinical outcomes, angina severity (Canadian Cardiovascular Scale), and quality of life (SF-36 questionnaire) were assessed at baseline and after 12 months of tailored anti-angina treatment based on pathophysiological background. A total of 150 patients were enrolled. At baseline 8% of patients had angina CCS I, 70% CCS II and 22% CCS III. After 12 months 46% had no angina symptoms, 22% had angina CCS I, 26% CCS II and 6% CCS III. Following tailored treatment, angina severity significantly decreased (p < 0.001). The quality of life (SF-36 questionnaire) was significantly better after 12 months compared to baseline (66 [45; 103] vs. 91 [69; 115] points; P < 0.001). In this observational study, a proposed care pathway for patients with INOCA was presented. Despite the observational nature of the study, both symptoms and quality of life improved, underscoring the need for future prospective randomized controlled trials. Further research, including adequately powered sample sizes of patients is warranted to evaluate the influence of pathophysiology-tailored treatment of INOCA on long-term major cardiovascular events.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".