In daily clinical practice, physicians often encounter patients with angina or those with evidence of myocardial ischemia from non-invasive tests but do not have obstructive coronary artery disease. This type of ischemic heart disease is referred to as ischemia with non-obstructive coronary arteries (INOCA). INOCA patients often suffer from recurrent chest pain without adequate management, and are associated with poor clinical outcomes. There are several endotypes of INOCA, and each endotype should be treated based on its specific underlying mechanism. Therefore, identifying INOCA and discriminating its underlying mechanisms are important issues and of clinical interest. Invasive physiologic assessment is the 1st step in the diagnosis of INOCA and discriminating the underlying mechanism, and additional provocation tests help physicians identify the vasospastic component in INOCA patients. Comprehensive information acquired from these invasive tests can provide a template for mechanism-specific management for patients with INOCA.

JACC: Asia Editor-in-Chief 

Jian’an Wang, MD, PhD, FACC

CME Editor 

Kenneth A. Ellenbogen, MD

Authors
Poonam Velagapudi, MD, MS

Muhammad Asim Shabbir, MD

Important Dates

Date of Release: April 18, 2023
Term of Approval/Date of CME/MOC/ECME Expiration: April 17, 2024