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Comprehensive Management of ANOCA, Part 1 – Definition, Patient Population, and Diagnosis: JACC State-of-the-Art Review (JACC September 2023-2)
Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly half of patients undergoing invasive coronary angiography for suspected ischemic heart disease. This working diagnosis encompasses coronary microvascular dysfunction, microvascular and epicardial spasm, myocardial bridging, and other occult coronary abnormalities. Patients with ANOCA often face a high burden of symptoms and may experience repeated presentations to multiple medical providers before receiving a diagnosis. Due to challenges establishing a diagnosis, patients with ANOCA frequently experience invalidation and recidivism, possibly leading to anxiety and depression. Advances in scientific knowledge and diagnostic testing now allow for routine evaluation of ANOCA non-invasively and in the cardiac catheterization laboratory with coronary function testing (CFT). CFT includes diagnostic coronary angiography, assessment of coronary flow reserve and microcirculatory resistance, provocative testing for endothelial dysfunction and coronary vasospasm, and intravascular imaging for identification of myocardial bridging, with hemodynamic assessment as needed. 

Valentin Fuster, MD, PhD, MACC

CME Editor
Ragavendra R. Baliga, MD

Rhanderson Cardoso, MD 

Important Dates
Date of Release: September 11, 2023

Term of Approval/Date of CME/MOC Expiration: September 10, 2024
Availability: On-Demand
Expires on Sep 10, 2024
Cost: FREE
Credit Offered:
1 CME Credit
1 ABIM-MOC Point
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