Changes in Ischemia and Angina Over 1 Year Among ISCHEMIA Trial Screen Failures With no Obstructive CAD on Coronary CT Angiography

Some people with chest pain are found to have open arteries on angiograms instead of blocked
arteries and many, but not all, of these people have abnormal stress tests or other tests
showing there is not enough blood flow to the heart. Prior research has not made clear
whether chest pain in such patients is due to heart disease or something else, in part
because no one has found out whether chest pain and stress test results change in the same
direction over time. This study will use two measurements of chest pain and two stress tests,
one year apart, to find out if chest pain and abnormal stress tests are both caused by the
same problem: not enough blood flow to the heart.The association between angina, ischemia and
atherosclerosis severity at baseline will be examined, as will medication effects.

Inclusion Criteria:

- Enrolled but not randomized in ISCHEMIA trial

- Stress echocardiography used for enrollment*

- No obstructive CAD on study coronary CT angiography (defined as no ≥50% stenosis in a
major epicardial vessel)

- Ischemic symptoms (chest pain or other potential ischemic equivalent).

- Participant is willing to give written informed consent

- Age ≥ 21 years

Exclusion Criteria:

- Inability to comply with protocol

- Prior PCI or CABG