Coronary interventions - Mini focus on ischaemia with non-obstructed coronary arteries

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

EuroIntervention 2021;16:1049-1069. DOI: 10.4244/EIJY20M07_01

Vijay Kunadian
Vijay Kunadian1; Alaide Chieffo2; Paolo G. Camici3; Colin Berry4; Javier Escaned5; Angela H.E.M. Maas6; Eva Prescott7; Nicole Karam8; Yolande Appelman9; Chiara Fraccaro10; Gill Louise Buchanan11; Stéphane Manzo-Silberman12; Rasha Al-Lamee13; Evelyn Regar14; Alexandra Lansky15,16; J. Dawn Abbott17; Lina Badimon18; Dirk J. Duncker19; Roxana Mehran20; Davide Capodanno21; Andreas Baumbach22,23
1. Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; 2. IRCCS San Raffaele Scientific Institute, Milan, Italy; 3. Vita Salute University and San Raffaele Hospital, Milan, Italy; 4. British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; 5. Hospital Clinico San Carlos IDISSC, Complutense University, Madrid, Spain; 6. Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; 7. Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark; 8. European Hospital Georges Pompidou (Cardiology Department), Paris University and Paris Cardiovascular Research Center (INSERMU970), Paris, France; 9. Department of Cardiology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, the Netherlands; 10. Department of Cardiac, Thoracic and Vascular Science and Public Health, Padova, Italy; 11. North Cumbria Integrated Care NHS Foundation Trust, Cumbria, United Kingdom; 12. Department of Cardiology, Lariboisie`re Hospital Paris University, Paris, France; 13. National Heart and Lung Institute, Imperial College London, London, United Kingdom; 14. Ludwig-Maximilians-University, Munich, Germany; 15. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA; 16. Bart’s Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom; 17. Lifespan Cardiovascular Institute and Warren Alpert Medical School of Brown University, Providence, RI, USA; 18. Cardiovascular Program-ICCC, IR-Hospital de la Santa Creu i Sant Pau, CiberCV, Barcelona, Spain; 19. Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; 20. Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA; 21. CardioThoracic-Vascular and Transplant Department, A.O.U. ‘Policlinico-Vittorio Emanuele’, University of Catania, Catania, Italy; 22. Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, United Kingdom; 23. Yale University School of Medicine, New Haven, CT, USA

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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