Endotyping-informed therapy for patients with chest pain and no obstructive coronary artery disease: a randomized trial.

In contemporary practice, most of these individuals do not undergo functional diagnostic tests, leaving the cause of the chest pain uncertain.

在当前的实践中，这些个体中的大多数没有接受功能性诊断测试，使得胸痛的原因不确定。

Stress cardiovascular magnetic resonance imaging (MRI) can be used to measure myocardial blood flow, detect coronary microvascular dysfunction and endotype individual patients, but evidence of clinical utility from randomized trials is lacking.

压力心血管磁共振成像（MRI）可用于测量心肌血流，检测冠状动脉微血管功能障碍并为个体患者分型，但来自随机试验的临床效用证据尚缺乏。

This study was a prospective, multicenter, parallel group, 1:1 randomized, controlled superiority trial of adenosine stress cardiovascular MRI-guided management in 250 patients (mean age, 63.3 years; 50.4% female) with chest pain and unobstructed coronary arteries.

本研究是一项前瞻性、多中心、平行组、1:1随机、对照优效试验，旨在评估250名患者（平均年龄63.3岁；50.4%为女性）在胸痛和冠状动脉无阻塞情况下的腺苷压力心血管MRI引导管理。

The primary outcome of the diagnostic study, defined as the reclassification of the initial diagnosis based on the angiogram, occurred in 131 patients (53.0% (95% confidence interval: 46.6-59.3%); P < 0.001), indicating that the primary outcome for the diagnostic study was met.

诊断研究的主要结果，即基于血管造影对初始诊断的重新分类，在131名患者中发生（53.0%（95%置信区间：46.6-59.3%）；P < 0.001），表明诊断研究的主要结果已经实现。

The primary outcome of the randomized trial was the Seattle Angina Questionnaire (SAQ) summary score at 12 months after randomization.

随机试验的主要结果是随机化后12个月的西雅图心绞痛问卷（SAQ）总分。

The mean ± s.d.

平均值 ± 标准差

SAQ summary scores at 12 months in the intervention and control groups were 70.9 ± 23.6 (21.7 ± 22.6 change from baseline) and 52.1 ± 24.1 (-0.8 ± 20.4 change from baseline) (adjusted mean difference: 20.9 (95% confidence interval: 15.8-26.0)), respectively, indicating that the primary outcome of the randomized trial was met.

干预组和对照组在12个月时的SAQ综合评分分别为70.9 ± 23.6（基线变化21.7 ± 22.6）和52.1 ± 24.1（基线变化-0.8 ± 20.4）（调整后平均差异：20.9（95%置信区间：15.8-26.0）），这表明随机试验的主要结果已经实现。

Improvements were also observed in the prespecified secondary outcome of the EQ-5D-5L questionnaire at 12 months (adjusted mean difference 0.09 (95% confidence interval: 0.04-0.13)).

在12个月时，预先设定的次要结果指标EQ-5D-5L问卷也显示出改善（调整后的平均差异为0.09（95%置信区间：0.04-0.13））。

In this study of patients with chest pain and unobstructed coronary arteries, endotyping-informed therapy revised the diagnosis in more than half of the participants and improved angina and health-related quality of life.

在这项针对胸痛且冠状动脉无阻塞的患者的研究中，基于内型的治疗重新诊断了超过一半的参与者，并改善了心绞痛和健康相关的生活质量。

ClinicalTrials.gov identifier: NCT04805814 .

临床试验注册号：NCT04805814 .