An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group

Vijay Kunadian, Alaide Chieffo, Paolo G Camici, Colin Berry, Javier Escaned, Angela H E M Maas, Eva Prescott, Nicole Karam, Yolande Appelman, Chiara Fraccaro, Gill Louise Buchanan, Stephane Manzo-Silberman, Rasha Al-Lamee, Evelyn Regar, Alexandra Lansky, J Dawn Abbott, Lina Badimon, Dirk J Duncker, Roxana Mehran, Davide Capodanno, Andreas Baumbach, Vijay Kunadian, Alaide Chieffo, Paolo G Camici, Colin Berry, Javier Escaned, Angela H E M Maas, Eva Prescott, Nicole Karam, Yolande Appelman, Chiara Fraccaro, Gill Louise Buchanan, Stephane Manzo-Silberman, Rasha Al-Lamee, Evelyn Regar, Alexandra Lansky, J Dawn Abbott, Lina Badimon, Dirk J Duncker, Roxana Mehran, Davide Capodanno, Andreas Baumbach

Abstract

This consensus document, a summary of the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), appraises the importance of ischaemia with non-obstructive coronary arteries (INOCA). Angina pectoris affects approximately 112 million people globally. Up to 70% of patients undergoing invasive angiography do not have obstructive coronary artery disease, more common in women than in men, and a large proportion have INOCA as a cause of their symptoms. INOCA patients present with a wide spectrum of symptoms and signs that are often misdiagnosed as non-cardiac leading to under-diagnosis/investigation and under-treatment. INOCA can result from heterogeneous mechanism including coronary vasospasm and microvascular dysfunction and is not a benign condition. Compared to asymptomatic individuals, INOCA is associated with increased incidence of cardiovascular events, repeated hospital admissions, as well as impaired quality of life and associated increased health care costs. This consensus document provides a definition of INOCA and guidance to the community on the diagnostic approach and management of INOCA based on existing evidence from research and best available clinical practice; noting gaps in knowledge and potential areas for further investigation.

The article has been co-published with permission in the European Heart Journal and EuroIntervention. All rights reserved. © 2020 the Author(s). These articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Mechanisms of myocardial ischaemia.
Figure 2
Figure 2
Mechanisms of myocardial ischaemia in INOCA and obstructive coronary artery disease. CAD, coronary artery disease; FFR, fractional flow reserve.
Figure 3
Figure 3
Non-invasive evaluation of INOCA. GP, general practitioner.
Figure 4
Figure 4
Invasive evaluation of INOCA. CFR, coronary flow reserve; FCA, functional coronary angiography; FFR, fractional flow reserve; IMR, index of microvascular resistance; LVEDP, left ventricular end-diastolic pressure. aAnd negative non-invasive or invasive testing for epicardial ischaemia. bCombo wire is an alternative option to measure FFR,CFR and IMR.
Figure 5
Figure 5
Management of INOCA. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker.
Figure 6
Figure 6
Key messages.
Take home figure
Take home figure
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/7577516/bin/ehaa503f7.jpg

Source: PubMed

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