Stress perfusion MRI-guided treatment eased distress in angina with no obstructive coronary disease

Design

Prospective multicentre randomised controlled superiority trial

Population

250 patients with chest pain and no obstructive coronary disease on invasive angiography

Primary outcome

Illness perception (BIPQ) and psychological health (PHQ-4)

Effect

BIPQ at 12 months −10.80 (95% CI −14.27 to −7.33); PHQ-4 −0.97 (−1.29 to −0.65)

CorCMR was a multicentre randomised superiority trial in 250 patients whose invasive angiography for chest pain showed no obstructive coronary artery disease. Half were assigned to stress perfusion cardiac MRI to define their ischaemic endotype, with treatment targeted to it; half received usual angiography-guided care. Mean age was 63 and half were women.

Illness perception, measured by the Brief Illness Perception Questionnaire, improved more with MRI-guided care at 6 months (adjusted difference −8.67, 95% CI −12.04 to −5.30) and 12 months (−10.80, −14.27 to −7.33). Anxiety and depression scores on the PHQ-4 also fell (−0.97 at 12 months, −1.29 to −0.65).

For radiologists, this is evidence that a stress perfusion study in this group does more than label microvascular disease — the diagnostic clarity itself changed how patients understood and coped with their symptoms. The outcomes are patient-reported in an unblinded comparison, so part of the effect may come from the extra attention of being investigated. Hard cardiovascular outcomes were not reported here.

• Offer stress perfusion MRI protocols for patients referred with angina and unobstructed coronaries where local capability exists
• Report perfusion findings in terms of endotype — microvascular, vasospastic, or non-cardiac — rather than only 'no significant stenosis'
• Agree a reporting template with cardiology so that the result leads to a named treatment plan
• Record myocardial perfusion reserve quantitatively where the sequence allows

Why it matters

'No significant stenosis' leaves many patients with chest pain uncertain and distressed, and an imaging-defined mechanism changed that.

Don't overread it

Outcomes were patient-reported in an open trial — this does not show fewer cardiac events.

The statistics, in plain English

A difference of about 11 points on an 80-point illness-perception scale is sizeable. The PHQ-4 difference of about 1 point on a 12-point scale is smaller and its clinical meaning is less clear. Because patients knew which care they received and reported the outcomes themselves, expectation may contribute to the effect.

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