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[Chronic coronary syndrome in patients with non-obstructive coronary arteries]

Ann Rantzau Kjær Pedersen1, Salma Karim1,2, Ashkan Eftekhari3

  • 1Hjertesygdomme, Regionshospitalet Viborg.

Ugeskrift for Laeger
|June 9, 2026
PubMed

Insights

Ischaemia with non-obstructive coronary arteries (INOCA) is often missed, particularly in women, leading to reduced quality of life. Diagnosis and tailored treatments based on INOCA endotype significantly improve patient outcomes.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Chronic coronary syndrome frequently presents as chest pain.
  • Ischaemia with non-obstructive coronary arteries (INOCA) is underdiagnosed and disproportionately affects women.
  • INOCA patients experience diminished quality of life and increased risk of major adverse cardiac events.

Purpose of the Study:

  • To review the diagnosis and management of INOCA.
  • To highlight the importance of identifying INOCA endotypes.
  • To summarize treatment strategies that improve quality of life.

Main Methods:

  • Literature review focusing on INOCA diagnosis and treatment.
  • Analysis of studies involving invasive functional testing for INOCA.
  • Evaluation of pharmacological and non-pharmacological treatment approaches.

Main Results:

  • INOCA symptoms stem from endothelial dysfunction, microvascular disease, or vasospastic disease.
  • Invasive functional testing is crucial for accurate diagnosis and endotyping.
  • Treatment guided by INOCA endotype improves patient quality of life.

Conclusions:

  • Accurate diagnosis and endotyping of INOCA are essential.
  • Multifaceted treatment strategies, tailored to the endotype, are effective.
  • Improving quality of life is a key outcome in INOCA management.

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