Ischemia With Non-Obstructive Coronary Artery Disease: Concept, Assessment and Management (JACC Asia April 2023)-Article: Ischemia With Non-Obstructive Coronary Artery Disease: Concept, Assessment and Management

Article: Ischemia With Non-Obstructive Coronary Artery Disease: Concept, Assessment and Management

Pdf Summary

Ischemia with Nonobstructive Coronary Artery Disease (INOCA) is a condition where patients exhibit symptoms of myocardial ischemia but without significant coronary artery blockages. Common in clinical practice, it often results in recurrent chest pain and poor outcomes due to inadequate management. There are various endotypes of INOCA, such as coronary microvascular disease and vasospastic angina, each requiring specific treatment strategies based on their underlying mechanisms.<br /><br />Diagnosis of INOCA involves a combination of invasive physiologic assessments, such as fractional flow reserve (FFR) and coronary flow reserve (CFR), and provocation tests to ascertain the presence of vasospasm. The differentiation between microvascular dysfunction and vasospastic angina is crucial for targeted management.<br /><br />Management of INOCA has no universally accepted standard. Coronary microvascular disease management includes the use of angiotensin-converting enzyme inhibitors (ACE), angiotensin receptor blockers (ARBs), and beta-blockers, aimed at improving vascular function and reducing ischemic symptoms. On the other hand, vasospastic angina is primarily treated with calcium-channel blockers and nitrates to alleviate and prevent coronary spasms. The evidence for these treatments, especially for microvascular spasms, is still evolving.<br /><br />Recent studies highlight the importance of identifying INOCA early and accurately through a structured diagnostic approach, owing to its association with adverse clinical outcomes. Ongoing research aims to refine these diagnostic criteria and evaluate the effectiveness of mechanism-specific treatments, potentially improving prognosis and quality of life for INOCA patients.

Keywords

Ischemia

Nonobstructive Coronary Artery Disease

INOCA

Myocardial Ischemia

Coronary Microvascular Disease

Vasospastic Angina

Fractional Flow Reserve

Coronary Flow Reserve

Calcium-Channel Blockers

Angiotensin-Converting Enzyme Inhibitors