Stress cardiac magnetic resonance (CMR)-guided management of patients with chest pain and nonobstructive coronary artery disease was superior to angiography-guided management alone in correctly diagnosing microvascular angina and improving chest pain symptoms and quality of life after six months to one year, based on findings from the CorCMR trial presented at AHA 2025.

The one-year study involved 250 adults with suspected angina and no obstructive coronary arteries (ANOCA). All participants had a coronary angiogram test within three months prior to enrollment in the study, as well as a stress CMR imaging once enrolled. Additionally, after six and 12 months, all participants were surveyed using the Seattle Angina Questionnaire to assess physical mobility, frequency and severity of chest pain, and quality of life.

Half of the participants and their physicians received their stress CMR imaging results to help guide diagnosis and treatment, while the other half (and their doctors) did not see the results and treatment decisions were based only on the angiogram conducted before study enrollment. Neither the participants nor their doctors knew which group they were assigned to until the study ended.

At 12 months, study results showed that disclosure of myocardial blood flow by stress CMR imaging improved identification of the cause of angina and led to better clinical outcomes. When physicians reviewed the stress CMR imaging, about 1 in 2 participants were diagnosed with microvascular angina, compared with fewer than 1 in 100 when physicians relied only on angiogram tests.

In presenting the findings, Colin Berry, MB, ChB, also noted that microvascular angina was commonly misdiagnosed as noncardiac chest pain in the angiography only group. Additionally, he added that the findings applied equally by sex and are particularly relevant to women with chest pain, of whom more than 50% were among those diagnosed with microvascular angina during the study period.

In other findings, quality-of-life scores were improved in the stress CMR imaging group, with small improvements at six months that became more pronounced after a year. According to researchers, participants in the stress cardiac MRI group improved by an average of 18 points at six months, and 22 points at one year, while participants in the angiography-guided group improved by less than 1 point. After one year, the difference in the QOL results between the two groups increased to about 21 points.

"By measuring blood flow with a stress cardiac MRI test, we found that small vessel problems were common," he said. "Our findings show that an angiogram alone is not always enough to explain chest pain. A functional test of blood flow should be considered before sending people home, especially women, who are more likely to have small vessel angina that otherwise goes unrecognized."

Looking to the future, further research is needed to confirm the findings in different health care settings and to test whether this approach may improve longer-term outcomes. Because chest pain from small vessels is often under-recognized, especially in women and among people in groups historically excluded from scientific research studies, future trials should also ensure these populations are well represented, researchers said.

Clinical Topics: Acute Coronary Syndromes, Noninvasive Imaging

Keywords: AHA Annual Scientific Sessions, AHA25, Acute Coronary Syndrome