Vericiguat did not improve peripheral vasodilator function or anginal symptoms in patients with angina and no obstructive coronary arteries (ANOCA) and with epicardial and/or microvascular vasospasm. However, based on findings from the ViVA trial presented at ESC Congress 2026 and simultaneously published in JACC, the sGC stimulator, was generally tolerated and no serious treatment-related adverse events occurred.

In the double blind, placebo-controlled, crossover trial, researchers randomized 57 patients to either vericiguat followed by placebo, or placebo followed by vericiguat. Each treatment period lasted 10 weeks, with patients beginning treatment with oral vericiguat (2.5 mg) or placebo once daily, then uptitrated to vericiguat (5 mg) or placebo at roughly 14 days. The final target dose of vericiguat (10 mg) was given at 28 days and then maintained for six weeks, with endpoint assessment at 70 days. A two-week washout period occurred before the crossover to the alternate treatment phase.

Compared with placebo, vericiguat did not improve peripheral vasodilator function (the primary outcome) when assessed by LASCA during acetylcholine iontophoresis. The difference in daily angina episodes between treatments (the primary symptom endpoint), appeared to favor placebo, but did not meet the prespecified criteria for efficacy or harm according to Hanae F. Namba, MD, et al.

In other findings, "vericiguat was generally tolerated, with modest reductions in blood pressure, no clinically relevant laboratory abnormalities, and no treatment-related serious adverse events." Additionally, episode counts and angina-free days beyond the 70-day assessment were similar between the vericiguat and placebo groups.

ViVA is unique in that it is the first randomized, placebo-controlled study to evaluate the effects of vericiguat on systemic vasodilator function and angina symptoms in patients with coronary vasospasm, according to investigators. "Most trials predate contemporary comprehensive ANOCA endotyping or lacked a placebo arm ... [and] consequently, treatment recommendations continue to rely largely on expert consensus rather than robust evidence," they write.

Looking ahead, the authors suggest that "larger studies with longer treatment exposure" could shed more light on the the potential clinical effects of vericiguat in this patient population.

Clinical Topics: Stable Ischemic Heart Disease, Chronic Angina

Keywords: ESC Congress, ESC26, Coronary Vasospasm, Arteries