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. 2020 Oct 1;41(37):3504-3520.
doi: 10.1093/eurheartj/ehaa503.

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  1 , Alaide Chieffo  2 , Paolo G Camici  3 , Colin Berry  4 , Javier Escaned  5 , Angela H E M Maas  6 , Eva Prescott  7 , Nicole Karam  8 , Yolande Appelman  9 , Chiara Fraccaro  10 , Gill Louise Buchanan  11 , Stephane Manzo-Silberman  12 , Rasha Al-Lamee  13 , Evelyn Regar  14 , Alexandra Lansky  15   16 , J Dawn Abbott  17 , Lina Badimon  18 , Dirk J Duncker  19 , Roxana Mehran  20 , Davide Capodanno  21 , Andreas Baumbach  22   23
Affiliations

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 et al. Eur Heart J. .

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.

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Figures

None
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
None
See this image and copyright information in PMC

References

    1. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1459–1544. - PMC - PubMed
    1. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ, ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: the Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 2020:41:407–477. - PubMed
    1. Reeh J, Therming CB, Heitmann M, Hojberg S, Sorum C, Bech J, Husum D, Dominguez H, Sehestedt T, Hermann T, Hansen KW, Simonsen L, Galatius S, Prescott E. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J 2019;40:1426–1435. - PubMed
    1. Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med 2007;356:830–840. - PubMed
    1. Jespersen L, Hvelplund A, Abildstrom SZ, Pedersen F, Galatius S, Madsen JK, Jorgensen E, Kelbaek H, Prescott E. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J 2012;33:734–744. - PubMed

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