Bastiany Alexandra, Pacheco Christine, Sedlak Tara, Saw Jaqueline, Miner Steven E S, Liu Shuangbo, Lavoie Andrea, Kim Daniel H, Gulati Martha, Graham Michelle M
Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
Hôpital Pierre-Boucher, Université de Montréal, Montreal, Quebec, Canada.
CJC Open. 2022 May 4;4(8):709-720. doi: 10.1016/j.cjco.2022.04.009. eCollection 2022 Aug.
Up to 65% of women and approximately 30% of men have ischemia with no obstructive coronary artery disease (CAD; commonly known as INOCA) on invasive coronary angiography performed for stable angina. INOCA can be due to coronary microvascular dysfunction or coronary vasospasm. Despite the absence of obstructive CAD, those with INOCA have an increased risk of all-cause mortality and adverse outcomes, including recurrent angina and cardiovascular events. These patients often undergo repeat testing, including cardiac catheterization, resulting in lifetime healthcare costs that rival those for obstructive CAD. Patients with INOCA often remain undiagnosed and untreated. This review discusses the symptoms and prognosis of INOCA, offers a systematic approach to the diagnostic evaluation of these patients, and summarizes therapeutic management, including tailored therapy according to underlying pathophysiological mechanisms.
在因稳定型心绞痛接受有创冠状动脉造影的患者中，高达65%的女性和约30%的男性存在缺血但无阻塞性冠状动脉疾病（CAD；通常称为INOCA）。INOCA可能是由于冠状动脉微血管功能障碍或冠状动脉痉挛所致。尽管没有阻塞性CAD，但患有INOCA的患者全因死亡率和不良结局（包括复发性心绞痛和心血管事件）的风险增加。这些患者经常接受重复检查，包括心脏导管插入术，导致终身医疗费用与阻塞性CAD患者相当。INOCA患者往往未被诊断和治疗。本综述讨论了INOCA的症状和预后，提供了对这些患者进行诊断评估的系统方法，并总结了治疗管理，包括根据潜在病理生理机制进行的个体化治疗。
