{
  "abstract": "Importance Women with angina due to suspected ischaemia referred for coronary angiography often have no obstructive coronary artery disease (ANOCA/INOCA).Objective To determine if intensive medical treatment (IMT) reduces major ischaemic events (major adverse cardiovascular event, MACE) among women with suspected ANOCA/INOCA.Design Randomised, prospective, blinded-outcomes evaluation.Setting 71 sites in the USA.Participants 2476 women with suspected ANOCA/INOCA.Interventions IMT-high intensity statin, ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) and aspirin versus usual care (UC).Main outcomes and measures Primary: all cause death, myocardial infarction, stroke/transient ischaemic attack, hospitalisation for angina or heart failure (MACE). Secondary: components of the primary, quality of life and win ratio.Results Recruitment was lower than planned (n=2476), yielding an aged population (mean, 64 years) with well-controlled blood pressure and low-density lipoprotein cholesterol at baseline, and relatively high rates of statin and ACEI/ARB use. At 2.5 years, 421 events occurred (221 in IMT, 200 in UC) with no difference in the primary outcome (HR=1.13 (95% CI 0.94 to 1.37) for IMT vs UC, p=0.20) or secondary outcomes. Hospitalisations for angina were the dominant contributor to MACE. Sensitivity analysis of contamination provided an estimated HR for IMT versus UC of 0.74 95% CI (0.352 to 1.558), p=0.43.Conclusions and relevance Among women with suspected ANOCA/INOCA, outcomes were dominated by chest pain and IMT did not improve outcomes, although limited power precludes concluding that it may not be helpful. The findings support the need for more investigation in this population with high burden of angina hospitalisation, health resource consumption and poor quality of life.Trial registration number NCT03417388.",
  "authors": [
    {
      "affiliations": [
        "Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA"
      ],
      "name": "Carl J Pepine"
    },
    {
      "affiliations": [
        "Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA"
      ],
      "name": "Eileen Handberg"
    },
    {
      "affiliations": [
        "Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA"
      ],
      "name": "Rhonda Cooper-DeHoff"
    },
    {
      "affiliations": [
        "Biostatistics Shared Resource, Cedars-Sinai Medical Center, Los Angeles, California, USA"
      ],
      "name": "Galen Cook-Wiens"
    },
    {
      "affiliations": [
        "Department of Population Health Science and Policy, Icahn School of Medicine, New York, New York, USA"
      ],
      "name": "Marcio A Diniz"
    },
    {
      "affiliations": [
        "Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA",
        "Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA"
      ],
      "name": "Susan Frayne"
    },
    {
      "affiliations": [
        "Division of Internal Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA"
      ],
      "name": "Margaret C Lo"
    },
    {
      "affiliations": [
        "Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA",
        "Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA"
      ],
      "name": "Steven M Smith"
    },
    {
      "affiliations": [
        "Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA"
      ],
      "name": "Barbara Harris"
    },
    {
      "affiliations": [
        "Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA"
      ],
      "name": "Janet Wei"
    },
    {
      "affiliations": [
        "Cardiovascular Department, St. Louis University School of Medicine, St. Louis, Missouri, USA"
      ],
      "name": "Bernard R Chaitman"
    },
    {
      "affiliations": [
        "Healthcare Institute for Innovations in Quality, University of Missouri-Kansas City, Kansas City, Missouri, USA",
        "St. Luke’s Mid America Heart Institute, Kansas City, Missouri, USA"
      ],
      "name": "John A Spertus"
    },
    {
      "affiliations": [
        "University of Glasgow, Glasgow, UK"
      ],
      "name": "Colin Berry"
    },
    {
      "affiliations": [
        "Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA"
      ],
      "name": "William Weintraub"
    },
    {
      "affiliations": [
        "Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA"
      ],
      "name": "C Noel Bairey Merz"
    }
  ],
  "title": "Women’s IschemiA TRial to Reduce Events In Non-ObstRuctive CAD (WARRIOR): a randomised controlled trial",
  "uid": "d72d350b-7a5a-5a13-b301-2be17afc77d9"
}