Evidence map›Paper›PMID 25712205›Full record

ArticleCirculation2015

Invasive evaluation of patients with angina in the absence of obstructive coronary artery disease.

Bong-Ki Lee, Hong-Seok Lim, William F Fearon, Andy S Yong, Ryotaro Yamada, Shigemitsu Tanaka, David P Lee, Alan C Yeung, Jennifer A Tremmel

2 registry-linked trialsAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 175 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
175citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT00823563 recruitingnot on this map

Evaluation of Patients With Angina in the Absence of Obstructive Coronary Artery Disease

Typeobservational_patient_registrySponsorStanford UniversityRan2007 to 2047Enrolled2,000ConditionsChest Pain, IschemiaArms30 cc blood draw, Intravascular ultrasound (IVUS), Coronary pressure/flow wire testing, Coronary pressure/flow testing: Acetycholine challenge, Procedure: Coronary pressure/flow testing: Nitroglycerin challenge
NCT02666235 phase2completednot on this map

A Randomised Controlled Trial of the Effect of Remote Ischaemic Conditioning on Coronary Endothelial Function in Patients With Angina.

TypeinterventionalSponsorNHS National Waiting Times Centre BoardRan2011 to 2016Enrolled60ConditionsIschemic Preconditioning, Coronary DiseaseArmsRemote ischaemic conditioning, Arm cuff placement, no inflation
3 · Its place in the literature

Who cites it

175 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Angiography-based coronary microvascular assessment with and without intracoronary pressure measurements: a systematic review.Clinical research in cardiology : official journal of the German Cardiac Society · 2024
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  11. Angiotensin-Converting Enzyme Inhibition Early After Heart Transplantation.Journal of the American College of Cardiology · 2017
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  16. Evaluation and Treatment of Myocardial Bridging by Clinical Phenotype.Journal of the Society for Cardiovascular Angiography & Interventions · 2026
    Review
  17. Unveiling the Microvasculature: The Index of Microcirculatory Resistance and Its Expanding Role in Cardiovascular Care.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026
    Review
  18. Article
  19. Prevalence and spectrum of coronary artery anomalies detected on coronary CT angiography.International journal of cardiology. Cardiovascular risk and prevention · 2026
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  20. Review

115 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Bong-Ki LeeFrom Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).
Hong-Seok LimFrom Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).
William F FearonFrom Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.). wfearon@stanford.edu.
Andy S YongFrom Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).
Ryotaro YamadaFrom Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).
Shigemitsu TanakaFrom Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).
David P LeeFrom Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).
Alan C YeungFrom Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).
Jennifer A TremmelFrom Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).

Funding

Sex Differences: Pathophysiology of Symptomatic Non-Obstructive Coronary DiseaseK23HL092233 · NHLBI · STANFORD UNIVERSITY · PI TREMMEL, JENNIFER ANN · 2009 to 2013
$680k
NHLBI NIH HHS K23 HL092233NHLBI NIH HHS K23 HL092233-05
6 · The paper itself

Abstract

backgroundMore than 20% of patients presenting to the cardiac catheterization laboratory with angina have no angiographic evidence of coronary artery disease. Despite a "normal" angiogram, these patients often have persistent symptoms, recurrent hospitalizations, a poor functional status, and adverse cardiovascular outcomes, without a clear diagnosis. METHODS AND

resultsIn 139 patients with angina in the absence of obstructive coronary artery disease (no diameter stenosis >50%), endothelial function was assessed; the index of microcirculatory resistance, coronary flow reserve, and fractional flow reserve were measured; and intravascular ultrasound was performed. There were no complications. The average age was 54.0±11.4 years, and 107 (77%) were women. All patients had at least some evidence of atherosclerosis based on an intravascular ultrasound examination of the left anterior descending artery. Endothelial dysfunction (a decrease in luminal diameter of >20% after intracoronary acetylcholine) was present in 61 patients (44%). Microvascular impairment (an index of microcirculatory resistance ≥25) was present in 29 patients (21%). Seven patients (5%) had a fractional flow reserve ≤0.80. A myocardial bridge was present in 70 patients (58%). Overall, only 32 patients (23%) had no coronary explanation for their angina, with normal endothelial function, normal coronary physiological assessment, and no myocardial bridging.

conclusionsThe majority of patients with angina in the absence of obstructive coronary artery disease have occult coronary abnormalities. A comprehensive invasive assessment of these patients at the time of coronary angiography can be performed safely and provides important diagnostic information that may affect treatment and outcomes.

Indexed as

Coronary Artery DiseaseAdultAgedAngina PectorisBlood Flow VelocityCoronary AngiographyCoronary CirculationFemaleFractional Flow Reserve, MyocardialHumansMaleMicrocirculationMiddle AgedUltrasonography, Interventionalchest painendotheliumfractional flow reserve, myocardialmyocardial bridging

Identifiers

PMID25712205
PMCPMC5295466

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.