Tudurachi Andreea, Anghel Larisa, Tudurachi Bogdan-Sorin, Zăvoi Alexandra, Ceasovschih Alexandr, Sascău Radu Andy, Stătescu Cristian
Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania.
Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania.
J Clin Med. 2024 Aug 7;13(16):4613. doi: 10.3390/jcm13164613.
Traditionally focused on obstructive atherosclerosis, contemporary research indicates that up to 70% of patients undergoing coronary angiography for angina and ischemic symptoms do not exhibit significant stenoses. Nonobstructive coronary artery disease (CAD) has emerged as a prevalent phenotype among these patients. This review emphasizes the emerging understanding that nonobstructive coronary artery disease, encompassing conditions such as ANOCA (Angina with No Obstructive Coronary Artery Disease), INOCA (Ischemia with No Obstructive Coronary Artery Disease), and MINOCA (Myocardial Infarction with No Obstructive Coronary Arteries), represents the most prevalent phenotype in cardiac patients. It delves into the complex pathophysiology underlying these conditions, focusing on microvascular dysfunction and coronary vasoreactivity, which contribute to myocardial ischemia despite the absence of significant coronary obstructions. Additionally, the review critically examines the limitations of current treatments which primarily target obstructive lesions and underscores the necessity for tailored therapies that address the specific microvascular and immunoinflammatory pathways involved in nonobstructive CAD. The main focus of this review is to advocate for a shift in diagnostic and therapeutic strategies to better identify and manage this widely prevalent yet under-recognized subset of CAD.
传统上主要关注阻塞性动脉粥样硬化，当代研究表明，因心绞痛和缺血症状接受冠状动脉造影的患者中，高达70%没有明显狭窄。非阻塞性冠状动脉疾病（CAD）已成为这些患者中一种普遍的表型。本综述强调了一种新的认识，即非阻塞性冠状动脉疾病，包括无阻塞性冠状动脉疾病的心绞痛（ANOCA）、无阻塞性冠状动脉疾病的缺血（INOCA）和无阻塞性冠状动脉的心肌梗死（MINOCA）等情况，是心脏病患者中最普遍的表型。它深入探讨了这些情况背后复杂的病理生理学，重点关注微血管功能障碍和冠状动脉血管反应性，这些因素在无明显冠状动脉阻塞的情况下导致心肌缺血。此外，该综述批判性地审视了当前主要针对阻塞性病变的治疗方法的局限性，并强调了针对非阻塞性CAD中涉及的特定微血管和免疫炎症途径进行个性化治疗的必要性。本综述的主要重点是倡导诊断和治疗策略的转变，以更好地识别和管理这一广泛存在但未得到充分认识的CAD亚组。
