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Comparison of International Expert Working Group Algorithms for Diagnosing Angina With Nonobstructive Coronary

Christopher C Y Wong1, Vedant S Pargaonkar2, Luke P Dawson2

  • 1Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA; Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.

JACC. Cardiovascular Interventions
|December 24, 2025
PubMed

Insights

The Microvascular Network (MVN) algorithm offers a higher diagnostic yield for angina with nonobstructive coronary arteries (ANOCA) endotypes than the European Association of Percutaneous Cardiovascular Interventions (EAPCI) algorithm. Testing for myocardial bridging and endothelial dysfunction is recommended for suspected ANOCA.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Internal Medicine

Background:

  • Coronary function testing (CFT) protocols for angina with nonobstructive coronary arteries (ANOCA) vary among expert groups.
  • The European Association of Percutaneous Cardiovascular Interventions (EAPCI) focuses on spasm and microvascular dysfunction.
  • The Microvascular Network (MVN) includes myocardial bridging and endothelial dysfunction assessments.

Purpose of the Study:

  • To compare the diagnostic yield of EAPCI and MVN algorithms in ANOCA patients.
  • Evaluate the effectiveness of different diagnostic strategies for ANOCA.

Main Methods:

  • Utilized fractional flow reserve, coronary flow reserve, index of microcirculatory resistance, intravascular ultrasound, and acetylcholine provocation.
  • Assessed myocardial bridging in patients with suspected ANOCA.

Main Results:

  • The MVN algorithm identified ANOCA in 88.2% of patients, versus 53.5% with EAPCI (P < 0.001).
  • MVN reclassified 66.7% of EAPCI's noncardiac chest pain patients and 84.3% of EAPCI's obstructive coronary artery disease patients into ANOCA endotypes.
  • Patients classified with cardiac chest pain by MVN had significantly lower Seattle Angina Questionnaire scores.

Conclusions:

  • The MVN algorithm demonstrates a superior diagnostic yield for ANOCA endotypes compared to the EAPCI algorithm.
  • Routine assessment for myocardial bridging and endothelial dysfunction is advised in suspected ANOCA cases.
Abstract

Keywords:
angina with nonobstructive arteriescoronary physiologycoronary vasomotor disordersendothelial dysfunctionmyocardial bridging

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