Practical Approach for Angina and Non-Obstructive Coronary Arteries: A State-of-the-Art Review

Area of Science:

• Cardiology
• Vascular Medicine
• Clinical Pathophysiology

Background:

• Anginal symptoms are common in patients lacking significant obstructive coronary artery disease (CAD).
• Vasomotor disorders of the coronary microcirculation, including abnormal vasodilation and coronary vasospasm, are increasingly identified as key underlying mechanisms.
• Managing these patients presents diagnostic and therapeutic challenges despite growing evidence.

Purpose of the Study:

• To offer a comprehensive review of the pathophysiological basis of angina in the context of non-obstructive coronary arteries.
• To discuss the diagnostic challenges and therapeutic strategies for this patient group.
• To present a practical management approach for patients experiencing angina with non-obstructive CAD.

Main Methods:

• Literature review focusing on pathophysiology, diagnosis, and treatment of angina with non-obstructive coronary arteries.
• Synthesis of current evidence regarding microvascular dysfunction and coronary vasospasm.
• Development of a practical clinical management framework.

Main Results:

• Non-obstructive CAD patients with angina often have underlying coronary vasomotor disorders.
• Diagnosis requires specialized assessment beyond standard angiography.
• Effective management strategies target microvascular function and vasospasm.

Conclusions:

• Angina in the absence of obstructive CAD is a distinct clinical entity driven by microvascular dysfunction or vasospasm.
• A systematic diagnostic and therapeutic approach is crucial for optimal patient outcomes.
• This review provides a practical guide for clinicians managing these complex cases.