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

Abstract

<jats:title>Abstract</jats:title> <jats:p>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.</jats:p>

Coronary Angiography-Derived Index of Microvascular Resistance

“…Receiver-operating curves of the caIMR, with the IMR as the gold standard, were estimated by using the logistic regression model. The cutoff value of 25 was applied to the IMR (Ford et al, 2020a;Kunadian et al, 2020) and receiver-operating curves were used to find a good correlation between caIMR and IMR. All statistical analyses were performed with a test significance level of 0.05.…”

“…Microvascular diseases have recently shown an increase in importance for the diagnosis and management of patients with chronic coronary syndrome (Kaski et al, 2018;Ford et al, 2020a;Knuuti et al, 2020;Kunadian et al, 2020). The pathological mechanisms for coronary microvascular diseases are heterogeneous Lanza, 2019).…”

“…The pathological mechanisms for coronary microvascular diseases are heterogeneous Lanza, 2019). Microvascular angina (MVA) features patients with normal coronary arteries and evidence of myocardial ischemia owing to coronary microvascular dysfunctions (Cannon and Epstein, 1988;Kunadian et al, 2020). This type of patients constitute >20% patients in the cardiac catheterization laboratory (Ford et al, 2018(Ford et al, , 2020b.…”

“…This type of patients constitute >20% patients in the cardiac catheterization laboratory (Ford et al, 2018(Ford et al, , 2020b. Although multiple non-invasive methods, such as PET and cardiac MRI, were suggested for assessment of the MVA (Kunadian et al, 2020), invasive methods are considered the gold standard. Fearon and his colleagues proposed an index of microcirculatory resistance (IMR) to quantify microcirculatory dysfunctions in patients with ischemic heart disease (IHD) (Fearon et al, 2003(Fearon et al, , 2004Aarnoudse et al, 2004), the measurements of which by a thermodilution wire in the maximal hyperemia were assumed to be remarkably reproducible as compared with other hemodynamic parameters (e.g., coronary flow reserve-CFR, hyperemic myocardial resistance-HMR, and hyperemic stenosis resistance-HSR) (Fearon et al, 2004;Pagonas et al, 2014).…”

Predicting Long-term Mortality in Patients with Stable Angina Across the Spectrum of Dysglycemia: A Machine Learning Approach

“…Since there is heterogeneity in pathogenesis among patients with stable angina, the European Society of Cardiology published associated guidelines to address differences in diagnosis and prognosis [9]. However, the optimal management strategy for patients with stable angina is still under debate, and a risk strati cation model to identify patients at high risk and to tailor personal management is warranted [10][11][12].…”