Available online 22 April 2025

Patients with angina and no obstructive coronary artery disease frequently have vasomotor dysfunction as the underlying mechanism for symptoms. Patients with vasomotor dysfunction have a high angina burden and their treatment frequently fails to reduce complaints sufficiently. Targeted therapies are currently unavailable due to heterogeneity in the patient population and incomplete understanding of the underlying pathophysiological mechanisms. One of the vasomotor dysfunction endotypes, epicardial spasm, is hypothesized to be a possible target for endothelin receptor antagonism treatment. The EDIT-CAS trial is a registry based, double blind, randomised, placebo-controlled clinical trial and aims to compare the efficacy of 10 weeks of add-on bosentan treatment versus placebo to prevent epicardial spasm at repeat spasm provocation test. Secondary and explorative outcomes are the effect on anginal complaints, safety of bosentan treatment, changes in coronary reactivity and the relationship between baseline endothelin levels and treatment success. We will include 100 patients with previously diagnosed epicardial vasospasm on a maximal triggering dose of 100 micrograms of acetylcholine and continuing angina(-like) symptoms at least weekly despite optimal medical treatment.

Vasospasm

randomized controlled trial

endothelin receptor antagonism

coronary function test

NL-CFT

treatment

Angina and no obstructive coronary artery disease

Aspartate-/alanine-amino-transferase

Coronary function test

Coronary Vasomotor Disorders International Study Group

Efficacy of Diltiazem to Improve Coronary Vasomotor Dysfunction in ANOCA

the Netherlands registry of invasive Coronary vasomotor Function Testing

Seattle angina questionnaire (summary score)

© 2025 The Author(s). Published by Elsevier Inc.