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Isquemia y enfermedad coronaria no obstructiva (INOCA): desarrollo de terapias basadas en la evidencia y agenda de
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
Resumen
Los pacientes con isquemia miocárdica sin obstrucción de las arterias coronarias se enfrentan a mayores riesgos de eventos cardiovasculares. Este informe de consenso describe las estrategias de gestión integradas e identifica las lagunas de investigación para esta condición.
Área de la Ciencia:
- Cardiología
- Investigación cardiovascular
Sus antecedentes:
- La isquemia miocárdica sin obstrucción arterial coronaria (INOCA) afecta a una población significativa de pacientes.
- Estos pacientes presentan un mayor riesgo de eventos cardiovasculares adversos, incluido el síndrome coronario agudo y la insuficiencia cardíaca.
- Un subconjunto de pacientes con INOCA presenta disfunción y inflamación microvascular coronaria.
Objetivo del estudio:
- Desarrollar un consenso sobre el síndrome de isquemia miocárdica sin arterias coronarias obstruidas.
- Proporcionar recomendaciones para un enfoque integrado de identificación y manejo de pacientes con INOCA.
- Identificar las lagunas de conocimiento y sugerir futuras direcciones de investigación.
Principales métodos:
- Convocó a un grupo de trabajo con representantes de las principales organizaciones cardiovasculares.
- Se revisó críticamente la literatura disponible y las prácticas actuales para la evaluación de riesgos.
- Centrado en el estado de las técnicas científicas y el desarrollo de terapias basadas en la evidencia.
Principales resultados:
- Los pacientes con INOCA tienen un riesgo elevado de eventos cardiovasculares e insuficiencia cardíaca con fracción de eyección preservada.
- La disfunción microvascular coronaria y la inflamación están presentes en un subgrupo de pacientes con INOCA.
- Identificó áreas clave para futuras investigaciones para avanzar en la gestión de INOCA.
Conclusiones:
- Se necesita un enfoque integrado para la identificación y gestión de INOCA.
- La investigación adicional es crucial para desarrollar terapias basadas en la evidencia para el INOCA.
- Abordar las lagunas de conocimiento mejorará los resultados para los pacientes con INOCA.
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