Impact of Coronary Function Testing on Symptoms and Quality of Life in Patients with Coronary Microvascular Dysfunction: Meta-Analysis of Randomised Controlled Trials.

Background/Objectives: A significant proportion of patients with angina undergoing invasive coronary angiography have no obstructive coronary artery disease (ANOCA), often due to coronary microvascular dysfunction (CMD). Coronary function testing (CFT) enables the physiological endotyping of these patients during angiography. This meta-analysis aimed to evaluate whether CFT-guided therapy improves angina symptoms and quality of life compared with standard angiography-guided care. Methods: Major databases were systematically searched for randomised controlled trials (RCTs) up to September 2025. The primary endpoint was angina severity; secondary endpoints included angina limitation, stability, frequency, treatment satisfaction, and quality of life. Pooled analyses were performed using a random-effects model with inverse-variance weighting to derive the weighted mean difference (95% confidence interval, CI). Results: Three RCTs involving 535 patients (mean age 60 years, 64% female) met inclusion criteria. The disclosure of CFT results did not significantly improve overall angina severity (mean difference: 6.00, 95% CI -2.32 to 14.33; p = 0.16), with considerate heterogeneity (I2 = 92%). No difference was observed for angina frequency or quality of life. In contrast, angina limitation, stability, and treatment satisfaction all favoured the CFT-disclosed group, although the results were heterogeneous. Conclusions: Invasive CFT appears feasible and clinically relevant in patients with ANOCA. Although several SAQ domains improved following physiology-guided management, these findings require cautious interpretation given the modest sample size and considerable heterogeneity. Larger, methodologically robust trials are warranted to clarify whether a CFT-guided strategy should be routinely integrated into the diagnostic and therapeutic pathway for ANOCA.