Multivessel compared to Single Vessel Functional Angiography to Diagnose Patients with No Obstructive Coronary Artery Disease: The MAD-NOCA trial

Many people have chest pain or heart symptoms but when they undergo a coronary angiogram (an X-ray of the heart's arteries), no major blockages are found. This condition — called ischaemia with no obstructive coronary artery disease, or INOCA — is not well understood and often dismissed, leaving patients in a frustrating cycle of ongoing symptoms and no clear diagnosis or treatment. However, growing research shows that problems with how the small coronary blood vessels function may be to blame. The MAD-NOCA trial is testing whether performing detailed testing on all three major coronary arteries (rather than just one, which is standard practice) leads to more accurate diagnoses and better treatment decisions. The testing involves measuring blood flow and how the vessels respond to specific drugs while a pressure wire is temporarily placed in the heart's arteries. You may be eligible if you are 18 or older, have undergone a coronary angiogram that showed no significant blockages, and have symptoms such as chest pain at rest, new exertion-related pain, or have been found to have a heart muscle condition or abnormal heart rhythm alongside chest symptoms. You would not be eligible if you have had a heart attack in the past 7 days, are in cardiogenic shock, are pregnant or breastfeeding, have had a major operation in the past 6 weeks, or have contraindications to the drugs used in the testing.