Endothelial Function Guided Therapy in Patients With Non-obstructive Coronary Artery Disease

Study Overview
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Brief Summary
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The purpose of this study is to systematically evaluate the clinical application value of vascular endothelial function examination in patients with non-obstructive coronary artery disease.

Detailed Description
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The study will be carried out in two stages. Phase I is mainly intended to evaluate the effects of vascular EFT on the prescription of doctors and the application rate of mid and long-term secondary prevention medication in patients. If the results are positive, the sample size and observation time will be further expanded in Phase II to evaluate its impact on the cardiovascular events of patients, as well as its cost-effectiveness.

Official Title
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Endothelial Function Guided Therapy in Patients With Non-obstructive Coronary Artery Disease (EndoFIND Study)

Conditions
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Non-obstructive Coronary Artery Disease

Intervention / Treatment
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* Other: Endothelial function guided therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1. Age: 18 years or older; 2. Patients with NOCAD defined by CT or CAG results of less than 50% occlusion; 3. Having signed their written informed consent. Exclusion Criteria: 1. Left ventricular ejection fraction ≤ 50%; 2. Serious endocrine diseases (severe hyperthyroidism, hypothyroidism); 3. Severe liver diseases (jaundice hepatitis, liver cirrhosis, liver failure); 4. Severe nephropathy (uremia, renal failure); 5. Severe inflammatory diseases (severe infection, lupus erythematosus, etc.); 6. Malignant tumor; 7. Mental disorders or cognitive disorders; 8. Participating in other interventional clinical trials; 9. There are any other factors that the treating doctors think are not suitable for inclusion or completion of this study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Multicenter, randomized, patient and assessor blinded, parallel control, two-stage, clinical trial. Phase I: a feasibility study to collect data on key process outcomes including physician's prescription behaviors, patients' cardiovascular risk, and trend of reduction in cardiovascular events, To create an initial and to inform for the Phase II larger multicenter trial on choosing clinical endpoints and sample size. Phase II: will extend all patients from Phase I to a longer period of follow up and recruit more new patients to enlarge the sample size, in order to have a full study on the effect of introducing EFT as a routine test in reducing clinical endpoint (major adverse cardiovascular events) among patients with NOCAD.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>Intervention group: Before the patient returns to the doctor and the prescription is issued, the EDCM system will feed back the EndoPAT test results to the responsible doctor through the automatically generated information on the doctor's mobile phone, but will not let the patient know the endothelium test results (blinded to the patient). | Other: Endothelial function guided therapy<br>* To evaluate the effect of integration of non invasive endothelial function test (EFT) as a routine test in increasing appropriate treatment to reduce cardiovascular risk including prescription of lipid, blood pressure and glucose lowering medications by physicians at the clinic for patients with non-obstructive coronary artery disease (NOCAD) and the effect of introducing EFT as a routine test in reducing clinical endpoint (major adverse cardiovascular events) among patients with non-obstructive coronary artery disease(NOCAD).<br>|
| No Intervention: Control group<br>Control group: The EDCM system will not report the EndoPAT test results to the responsible doctor (the doctor cannot see the final EFT results), nor can the patients know the EFT results. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compliance rate of patients to physicians prescription | The incidence number of patients compliance to guidelines based medical therapy with prescription of cholesterol, blood pressure and glucose lowering medications by physicians at clinic for patients with non-obstructive coronary artery disease. | up to 30 months | 
| Total incidence number of Major Adverse Cardiovascular Events | The incidence number of MACE(Major Adverse Cardiovascular Events) including total death, non-fatal AMI or stroke(including stroke revascularization). | up to 54 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean improvement of endothelial function | The mean improvement in endothelial function from baseline to 12 months, estimated by RHI(Reactive Hyperemia Index). | up to 30 months | 
| Incidence number of Major Adverse Cardiovascular Events | The incidence number of MACE(Major Adverse Cardiovascular Events) during 0 to 12 months | up to 30 months | 
| Reduction of lipid levels | The reduction in lipid levels from baseline to 12 months | up to 30 months | 
| Reduction of blood pressure | The reduction in blood pressure from baseline to 12 months | up to 30 months | 
| Compliance rate of patients with treatment target | The percentage of patients with treatment target attained in terms of hypertension, diabetes, and dyslipidemia at 12 months after baseline. | up to 30 months | 
| Compliance rate of patients with appropriate prescription by physicians | The percentage of patients with appropriate prescription of cholesterol, blood pressure and glucose lowering medications by physicians at 3, 6 and 12 months after baseline. | up to 30 months | 
| Compliance rate of patients with healthy life style | The percentage of patients with healthy life style at 3, 6 and 12 months after baseline. The healthy life style is defined as having no smoking, physical activities with at least 3 times a week and 30 min per time, BMI<25 Kg/M2. | up to 30 months | 
| Cost-effectiveness rate of Endothelial Function Testing | The cost-effectiveness incremental ratio of Endothelial Function Testing in reducing MACE(Major Adverse Cardiovascular Events) . | up to 54 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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non invasive endothelial function test, non-obstructive coronary artery disease, Major Adverse Cardiovascular Events