A Multidomain Lifestyle Intervention for Invasively Confirmed ANOCA: The SAMCRO Randomized Trial.
Summary
In the multicenter SAMCRO randomized trial, 123 patients with invasively confirmed coronary microvascular dysfunction and/or coronary vasomotor disorder received endotype-guided therapy with or without structured exercise, Mediterranean dietary counseling, and psychological support. At 12 months, the intervention improved the Seattle Angina Questionnaire summary score by 13.12 points versus control, and clinically meaningful improvement occurred in 77% versus 38% of participants.
Key Findings
- The trial randomized 123 patients with invasively confirmed ANOCA to multidomain lifestyle intervention or control.
- The adjusted between-group improvement in Seattle Angina Questionnaire summary score was 13.12 points at 12 months.
- Clinically meaningful improvement of at least 10 points occurred in 77% of the intervention group versus 38% of controls.
- EuroQol 5-Dimension 5-Level and Beck Depression Inventory scores also improved with intervention.
Clinical Implications
For patients with ANOCA, clinicians should consider structured cardiac rehabilitation, Mediterranean dietary counseling, and psychological support in addition to mechanism-based medical therapy. The findings support multidisciplinary pathways rather than relying solely on antianginal medication or repeated anatomical testing.
Why It Matters
This trial provides randomized evidence that a structured, nonpharmacological, multidomain intervention can improve patient-reported outcomes in a population with substantial symptom burden and historically limited treatment options. It directly supports integrating exercise, diet, and psychological care into endotype-guided ANOCA management.
Limitations
- The sample size was modest at 123 randomized participants.
- The intervention was multidomain, so the independent effects of exercise, diet, and psychological support cannot be separated.
- The primary outcomes were patient-reported and the abstract does not establish effects on hospitalization, myocardial infarction, or mortality.
Future Directions
Larger pragmatic trials should assess the durability of benefit, adherence, cost-effectiveness, and effects on recurrent health-care use and cardiovascular events. Factorial designs could identify the most effective components, and implementation studies should evaluate delivery through cardiac rehabilitation and primary-care networks.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment/Prevention
- Evidence Level
- I - Prospective multicenter randomized trial with blinded endpoint assessment, although the sample size was modest and clinical event outcomes were not established.
- Study Design
- OTHER