ArticleCirculation2021
Natural History of Patients With Ischemia and No Obstructive Coronary Artery Disease: The CIAO-ISCHEMIA Study.
Article in Circulation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02347215 (Changes in Ischemia and Angina Over One Year Among ISCHEMIA Trial Screen Failures), which is not on this map. Cited by 55 papers, 2 of them syntheses that pooled it.
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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.
Changes in Ischemia and Angina Over One Year Among ISCHEMIA Trial Screen Failures
Who cites it
55 citing papers in PubMed, 2 syntheses or guidelines pooled it, 91 citations in OpenAlex.
- Understanding Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): a comprehensive meta-analysis of clinical characteristics, management, and prognosis compared to MI with the Obstructive Coronary Artery (MIOCA).BMC cardiovascular disorders · 2025Pooled it
- Sex differences in saphenous vein graft patency: A systematic review and meta-analysis.Journal of cardiac surgery · 2022Pooled it
- Determining the Physiological Threshold for Angina (ORBITA-FIRE): A Double-Blind, Randomized, Placebo-Controlled Study.Circulation · 2026Trial
- Sex Differences in Psychosocial Factors and Angina in Patients With Chronic Coronary Disease.Journal of the American Heart Association · 2025Trial
- Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial.JACC. Cardiovascular imaging · 2023Trial
- Comparison of risk profiles of participants in the Women's IschemiA TRial to Reduce events In non-ObstRuctive CAD (WARRIOR) trial, using Coronary Computed Tomography Angiography vs Invasive Coronary Angiography.Progress in cardiovascular diseasesTrial
- Interpreting ECG-Based Risk Stratification in Women With INOCA: Methodological Considerations From the WISE Cohort.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026Article
- Sex-Related Long-Term Outcomes in On-Pump Coronary Artery Bypass Grafting-A Propensity Score-Matched Analysis.Interdisciplinary cardiovascular and thoracic surgery · 2026Article
- Electrocardiographic Predictors of Major Adverse Cardiovascular Events in Women With Suspected Ischemia and no Obstructive Coronary Artery Disease: Results of the Women's Ischemia Syndrome Evaluation.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026Article
- Sex-specific differences in coronary blood flow dynamics during coronary artery bypass surgery.Journal of cardiothoracic surgery · 2026Article
- The Potential Role of Baseline FT3/FT4 Ratio as a Prognostic Biomarker for Patients With Ischemic Non-Obstructive Coronary Artery Disease.Clinical cardiology · 2026Article
- Persistent chest pain trends at 3 years in women with INOCA vs. obstructive CAD: results from the NHLBI-sponsored women's ischemia syndrome evaluation (WISE).European heart journal. Quality of care & clinical outcomes · 2026Article
- Barriers and facilitators to the uptake of the Ischaemia with Non-Obstructive Coronary Arteries (INOCA) recommendation by cardiologists in the Netherlands: A qualitative study.International journal of cardiology. Cardiovascular risk and prevention · 2025Article
- Underpinnings of heart failure with preserved ejection fraction in women - From prevention to improving function. A co-publication with the American Journal of Preventive Cardiology and the Journal of Cardiac Failure.American journal of preventive cardiology · 2025Article
- Multimodality Imaging for Diagnosis of Ischemic Heart Disease in Latin American Women from IAEA (International Atomic Energy Agency) Collaboratory.Current cardiology reports · 2025Review
- Adenosine stress myocardial perfusion imaging and myocardial work in evaluating INOCA.Scientific reports · 2025Article
- Societal, occupational, and economic considerations for women with (M)INOCA: a narrative review.International journal of occupational medicine and environmental health · 2025Review
- The role of cardiac imaging in the post-ISCHEMIA world.The British journal of radiology · 2025Review
- Beneficial effects of metformin treatment in hyperglycaemic patients affected by ischaemia with no obstructive coronary artery.Cardiovascular research · 2025Article
- Quantitative Coronary Artery Plaque Parameters and Severity of Ischemia in Patients With INOCA.Circulation. Cardiovascular imaging · 2025Article
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Authors and funding
24 authors at 19 institutions in 10 countries.
Funding
Abstract
backgroundIschemia with no obstructive coronary artery disease (INOCA) is common and has an adverse prognosis. We set out to describe the natural history of symptoms and ischemia in INOCA.
methodsCIAO-ISCHEMIA (Changes in Ischemia and Angina over One Year in ISCHEMIA Trial Screen Failures With INOCA) was an international cohort study conducted from 2014 to 2019 involving angina assessments (Seattle Angina Questionnaire) and stress echocardiograms 1 year apart. This was an ancillary study that included patients with a history of angina who were not randomly assigned in the ISCHEMIA trial. Stress-induced wall motion abnormalities were determined by an echocardiographic core laboratory blinded to symptoms, coronary artery disease status, and test timing. Medical therapy was at the discretion of treating physicians. The primary outcome was the correlation between the changes in the Seattle Angina Questionnaire angina frequency score and changes in echocardiographic ischemia. We also analyzed predictors of 1-year changes in both angina and ischemia, and we compared CIAO participants with ISCHEMIA participants with obstructive coronary artery disease who had stress echocardiography before enrollment, as CIAO participants did.
resultsINOCA participants in CIAO were more often female (66% of 208 versus 26% of 865 ISCHEMIA participants with obstructive coronary artery disease,
conclusionsImprovement in ischemia and angina were common in INOCA but not correlated. Our INOCA cohort had a degree of inducible wall motion abnormalities similar to concurrently enrolled ISCHEMIA participants with obstructive coronary artery disease. Our results highlight the complex nature of INOCA pathophysiology and the multifactorial nature of angina. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02347215.
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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.