How to Diagnose and Manage Angina Without Obstructive Coronary Artery Disease: Lessons from the British Heart Foundation CorMicA Trial

Thomas J Ford, Colin Berry, Thomas J Ford, Colin Berry

Abstract

Patients with symptoms and/or signs of ischaemia but no obstructive coronary artery disease (INOCA) present a diagnostic and therapeutic challenge. Microvascular and/or vasospastic angina are the two most common causes of INOCA; however, invasive coronary angiography lacks the sensitivity to diagnose these functional coronary disorders. In this article, the authors summarise the rationale for invasive testing in the absence of obstructive coronary disease, namely that correct treatment for angina patients starts with the correct diagnosis. They provide insights from the CORonary MICrovascular Angina (CorMicA) study, where an interventional diagnostic procedure was performed with linked medical therapy to improve patient health. Identification of these distinct disorders (microvascular angina, vasospastic angina or non-cardiac chest pain) is key for stratifying INOCA patients, allowing prognostic insights and better patient care with linked therapy based on contemporary guidelines. Finally, they propose a framework to diagnose and manage patients in this common clinical scenario.

Keywords: Stable angina pectoris; coronary physiology; coronary vasoreactivity testing; elective coronary angiography; ischaemia; microvascular angina; vasospastic angina.

Conflict of interest statement

Disclosure: TJF has no conflicts of interest. CB is employed by the University of Glasgow, which holds consultancy and research agreements with companies that have commercial interests in the diagnosis and treatment of angina. These companies include Abbott Vascular, AstraZeneca, Boehringer Ingelheim, GSK, Menarini Pharmaceuticals, Opsens, Philips and Siemens Healthcare. CorMicA study is an investigator-initiated clinical trial that was funded by the British Heart Foundation (PG/17/2532884; RE/13/5/30177; RE/18/634217). Clinicaltrials.gov: NCT03193294.

Figures

Figure 1:. Ischaemia with No Obstructive Coronary…
Figure 1:. Ischaemia with No Obstructive Coronary Artery Disease: A Coronary Syndrome
Figure 2:. Interventional Diagnostic Procedure in Ischaemia…
Figure 2:. Interventional Diagnostic Procedure in Ischaemia with No Obstructive Coronary Artery Disease for Diagnosis and Stratified Management
Figure 3:. Prevalence and Treatment of Ischaemia…
Figure 3:. Prevalence and Treatment of Ischaemia with No Obstructive Coronary Artery Disease

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