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Angina pectoris and myocardial ischemia in the absence of obstructive coronary artery disease: practical

Francesco Radico1, Vincenzo Cicchitti1, Marco Zimarino1

  • 1Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.

JACC. Cardiovascular Interventions
|April 22, 2014
PubMed

Insights

Patients with angina and myocardial ischemia but no obstructive coronary artery disease often lack further investigation. A systematic diagnostic approach is crucial for identifying underlying functional coronary artery diseases and guiding treatment for better prognosis.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Diagnostic Testing

Background:

  • Angina and myocardial ischemia without obstructive coronary artery disease (INOCA) are common.
  • These patients are often undertreated due to a perceived good prognosis.
  • Absence of obstructive coronary artery disease does not equate to a healthy coronary system.

Purpose of the Study:

  • To highlight the importance of investigating INOCA.
  • To discuss diagnostic principles for functional coronary artery diseases.
  • To propose a practical diagnostic sequence for risk stratification.

Main Methods:

  • Review of diagnostic principles for epicardial and microvascular coronary dysfunction.
  • Proposal of a systematic diagnostic pathway.
  • Emphasis on post-angiography assessment.

Main Results:

  • Functional coronary artery diseases (epicardial, microvascular, or both) can cause ischemia in INOCA.
  • Accurate diagnosis has significant prognostic and therapeutic implications.
  • A structured diagnostic approach can identify at-risk patients.

Conclusions:

  • Systematic assessment of coronary artery function is essential in INOCA.
  • Early and accurate diagnosis improves patient outcomes.
  • A proposed diagnostic sequence aids in identifying patients needing further cardiac event risk management.

Keywords:
anginacardiac syndrome Xcoronary microcirculationcoronary spasmendothelial dysfunctionmyocardial ischemianormal coronary arteries

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