A Practical Approach to Invasive Testing in Ischemia With No Obstructive Coronary Arteries (INOCA)

The invasive investigation of INOCA in the coronary catheterization lab

“…These data support other observational findings which have shown that INOCA has an impact on both quality of life and on prognosis [ 2 , 3 , [7] , [8] , [9] , [10] , [11] ]. The prognosis of patients with microcirculatory dysfunction in patients with CCS is poorer than originally thought.…”

“…Both agents are considered safe when selectively infused into a single coronary artery, when used in conjunction intracoronary with nitrates used post provocation to relieve spasm. However VT/VF or bradyarrhythmia is reported in 3 % of patients [ 8 ].…”

“…Incremental doses of acetylcholine can be used from 20μg, 50μg, 100μg given at 5 min intervals over 20 s in a total volume of 5 ml and, the diagnostic angiogram is performed 1 min after the start of the acetylcholine injection [ 8 ]. Alternatively IV infusions at 0.182, 1.82, and 18.2μg/ml at 1 ml/min for 2 min periods using a infusion pump have also been described [ 8 ].…”

“…Incremental doses of acetylcholine can be used from 20μg, 50μg, 100μg given at 5 min intervals over 20 s in a total volume of 5 ml and, the diagnostic angiogram is performed 1 min after the start of the acetylcholine injection [ 8 ]. Alternatively IV infusions at 0.182, 1.82, and 18.2μg/ml at 1 ml/min for 2 min periods using a infusion pump have also been described [ 8 ]. The LAD is usually used for provocation testing, these tests can be repeated in the RCA but use of a maximum bolus dose of 80mch is recommended, and some authors also recommend placing a temporary wire before testing the RCA.…”

“…The strategy employed in the CorMicA trial [ 6 ] provides a stepwise evidence-based treatment plan in keeping with other published guidelines and consensus documents [ 2 , 7 , 8 ]. CorMicA used baseline therapy of aspirin, statin, and ACE inhibitor for all patients, with GTN as required.…”