Ang Daniel Tze Yee, Berry Colin
University of Glasgow Glasgow, UK.
Golden Jubilee National Hospital Clydebank, UK.
Interv Cardiol. 2021 Aug 12;16:e32. doi: 10.15420/icr.2021.16. eCollection 2021 Apr.
Ischaemia with non-obstructed coronary artery disease (INOCA) remains a diagnostic and therapeutic challenge. An anatomical investigationbased approach to ischaemic heart disease fails to account for disorders of vasomotion. The main INOCA endotypes are microvascular angina, vasospastic angina, mixed (both) or non-cardiac symptoms. The interventional diagnostic procedure (IDP) enables differentiation between clinical endotypes, with linked stratified medical therapy leading to a reduced symptom burden and a better quality of life. Interventionists are therefore well placed to make a positive impact with more personalised care. Despite adjunctive tests of coronary function being supported by contemporary guidelines, IDP use in daily practice remains limited. More widespread adoption should be encouraged. This article reviews a stratified approach to INOCA, describes a streamlined approach to the IDP and highlights some practical and safety considerations.
非阻塞性冠状动脉疾病（INOCA）所致的缺血仍然是一个诊断和治疗难题。基于解剖学检查的缺血性心脏病研究方法无法解释血管运动障碍。INOCA的主要亚型为微血管性心绞痛、血管痉挛性心绞痛、混合型（两者皆有）或非心脏症状。介入诊断程序（IDP）能够区分临床亚型，与之相关的分层药物治疗可减轻症状负担，提高生活质量。因此，介入医生能够通过更个性化的治疗产生积极影响。尽管当代指南支持进行冠状动脉功能辅助检查，但IDP在日常实践中的应用仍然有限。应鼓励更广泛地采用。本文回顾了INOCA的分层治疗方法，描述了IDP的简化流程，并强调了一些实际操作和安全注意事项。
