Metoprolol for Coronary Artery Disease
(POINT-NOCAD Trial)

Recruiting in Palo Alto (17 mi)

Overseen byNathaniel Smilowitz, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: NYU Langone Health

No Placebo Group

Trial Summary

What is the purpose of this trial?Among patients with ischemic heart disease who are referred for coronary angiography, a substantial proportion have non-obstructive coronary artery disease (CAD). Myocardial infarction (MI) with non-obstructive coronary artery disease (MINOCA) accounts for 5-20% of patients with MI and preferentially affects women. MINOCA pathogenesis is varied and may include atherosclerotic plaque rupture, plaque erosion with thrombosis, vasospasm, embolization, dissection or a combination of mechanisms. Other patients may have clinically unrecognized myocarditis, or takotsubo syndrome masquerading as MI. Among patients referred for coronary angiography for the evaluation of stable ischemic heart disease, non-obstructive CAD is present in up to \~30% of men and \~60% of women. Stable ischemia with non-obstructive coronary arteries (INOCA) may be due to coronary microvascular dysfunction in up to 40% of these patients. Our understanding of mechanisms of MINOCA and INOCA remain incomplete. Coronary inflammation has been hypothesized as a potential mechanism contributing to coronary spasm in MINOCA and microvascular disease in INOCA.

Eligibility Criteria

This trial is for adults over 18 with stable ischemic heart disease or acute myocardial infarction needing coronary angiography. It's not for those with poor kidney function, allergies to iodine contrast media, pregnant individuals, or anyone with significant blockage in their heart arteries.

Inclusion Criteria

I have stable heart disease or had a recent heart attack.

I am 18 or older and have been referred for a heart artery check.

Exclusion Criteria

My kidney function is normal or only mildly reduced.

You are allergic to the dye used in angiographic or catheterization procedures.

Clinical Exclusion criteria: History of allergic reaction to iodinated contrast media

+2 more

Participant Groups

The study tests if Metoprolol (a beta-blocker), Isovue and Nitroglycerin (both related to imaging procedures), along with CCTA scans can help understand inflammation in patients who have chest pain but no major artery blockages.

1Treatment groups

Experimental Treatment

Group I: Intervention groupExperimental Treatment4 Interventions

Participants will be identified by review of the cardiac catheterization laboratory schedule each day by the principal investigator, a co-investigator, or a research coordinator. Participants with no obstructive CAD and completed microvascular testing will undergo a research CCTA.