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Ischemia and No Obstructive Coronary Artery Disease (INOCA): Developing Evidence-Based Therapies and Research Agenda

C Noel Bairey Merz1, Carl J Pepine2, Mary Norine Walsh2

  • 1From Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Division of Cardiology, University of Florida, Gainesville (C.J.P.); St. Vincent Heart Transplant, Indianapolis, IN (M.N.W.); and National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.). merz@cshs.org.

Circulation
|March 15, 2017
PubMed

Insights

Patients with myocardial ischemia with no obstructive coronary arteries face higher cardiovascular event risks. This consensus report outlines integrated management strategies and identifies research gaps for this condition.

Area of Science:

  • Cardiology
  • Cardiovascular Research

Background:

  • Myocardial ischemia with no obstructive coronary arteries (INOCA) affects a significant patient population.
  • These patients exhibit increased risk for adverse cardiovascular events, including acute coronary syndrome and heart failure.
  • A subset of INOCA patients presents with coronary microvascular dysfunction and inflammation.

Purpose of the Study:

  • To develop a consensus on the syndrome of myocardial ischemia with no obstructive coronary arteries.
  • To provide recommendations for an integrated approach to identifying and managing INOCA patients.
  • To outline knowledge gaps and suggest future research directions.

Main Methods:

  • Convened a working group with representatives from major cardiovascular organizations.
  • Critically reviewed available literature and current practices for risk assessment.
  • Focused on state-of-the-science techniques and evidence-based therapy development.

Main Results:

  • Patients with INOCA have an elevated risk for cardiovascular events and heart failure with preserved ejection fraction.
  • Coronary microvascular dysfunction and inflammation are present in a subgroup of INOCA patients.
  • Identified key areas for future research to advance INOCA management.

Conclusions:

  • An integrated approach is needed for the identification and management of INOCA.
  • Further research is crucial to develop evidence-based therapies for INOCA.
  • Addressing knowledge gaps will improve outcomes for patients with INOCA.

Keywords:
heart diseasesischemia

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