50 Ischaemia and No Obstructive Coronary Artery Disease (INOCA): prevalence and predictors of coronary vasomotion disorders

Abstract

(4.6%), VT=1 (0.3%). ANS referrals resulted in greater trend towards change of management (38.2%) of patients compared with GC (32.7%) and EP (31.4%) (p=0.593 nurse vs. consultant). For those needing pacing, 24 were from ANS referrals compared to 25 for clinicians (23.5% vs 18.3% respectively, p=0.012). Median time to developing a pacing indication was 2.6 months for ANS and 4.1 months for clinicians; 25 had pacing indication within 3 months of ILR insertion. Overall, an ILR had a diagnostic yield of 34.1% (n= 104) (table 1). Conclusion The diagnostic yield of ILR insertion was 34%. ANS referrals trended towards greater diagnostic yield compared with clinicians and significantly more pacemaker indications. Our data suggest ANS patient selection for ILRs are at least comparable to clinicians.

Percutaneous coronary intervention and 30‐day unplanned readmission with chest pain in the United States (Nationwide Readmissions Database)

“…This group of disorders includes microvascular angina, vasospastic angina or mixed microvascular/vasospastic angina, in the absence of obstructive (≥50% diameter stenosis) or flow‐limiting (fractional flow reserve ≤0.80; non‐hyperemic pressure ratio ≤ 0.89) CAD 13 . Patients with INOCA have a burden of anginal symptoms and typically poorer quality of life compared to patients with obstructive CAD 14 . Microvascular angina may be associated with obstructive CAD (Type 3 microvascular angina), or, alternatively, CAD may be falsely classified as obstructive when in fact the primary cause of angina is microvascular disease.…”

Chest pain: when in doubt…

“…Mild myocarditis was less likely in the absence of an infective prodrome and a clinical presentation most in keeping with acute ischaemia, although cardiac magnetic resonance (CMR) may be a useful test when there is clinical uncertainty. Microvascular dysfunction is a recognised cause of ischaemia3 but typically presents with a history of angina rather than a discrete episode of myocardial infarction. Similarly, coronary artery spasm usually presents with episodic chest pain of diurnal variation that responds rapidly to nitrates.…”

Vasomotor dysfunction in patients with angina and nonobstructive coronary artery disease is dominated by vasospasm

“…(10) Tailored treatment improves symptoms and quality of life. (11,12) Endotypes can be distinguished by an invasive coronary function test (CFT), using acetylcholine (ACH) (or equivalent) to evaluate coronary spasm and adenosine to evaluate IMD. (6) The most recent European Society of Cardiology guideline for chronic coronary syndromes as well as the latest expert consensus document, recommend to consider a CFT in all patients with ANOCA with persistent anginal symptoms.…”