Toleva Olga, Smilowitz Nathaniel R, Quesada Odayme, Kesarwani Manoj, Savage Michael P, Prasad Megha, Barseghian El-Farra Ailin, Holoshitz Noa, Moses Jeffrey W, Fearon William F, Tremmel Jennifer A, Samuels Bruce, Henry Timothy D
Georgia Heart Institute, Northeast Georgia Medical Centre, Gainesville, Georgia.
Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, New York.
J Soc Cardiovasc Angiogr Interv. 2025 Apr 15;4(7):102633. doi: 10.1016/j.jscai.2025.102633. eCollection 2025 Jul.
Although the techniques for coronary function testing (CFT) were largely developed more than 30 years ago, consensus on the specific diagnostic criteria and endotypes is still lacking. Furthermore, the management of patients with angina with nonobstructive coronary arteries (ANOCA) is challenging for most cardiologists. These patients are often a burden to the health care system due to recurrent presentations to the emergency room, repeated coronary angiography, and lack of improvement in their anginal symptoms even after being properly diagnosed with CFT. Therapies for coronary microvascular dysfunction, coronary vasospasm, and myocardial bridging have been tested in small trials and only a few randomized controlled trials. However, we are still limited in the options of therapies that we can offer to our patients. Although techniques and principles of CFT have advanced significantly, the art of managing patients with ANOCA is very challenging. A dedicated comprehensive summary of all contemporary treatment options for ANOCA is needed to guide clinicians in managing this challenging population of patients. This article subdivides ANOCA into 3 major categories: coronary microvascular dysfunction, coronary vasospasm, and myocardial bridging. Patients with ANOCA may present with 1 or a combination of the described categories. We describe major pillars in managing ANOCA patients: risk factors and lifestyle changes, traditional pharmacotherapy, device therapies, and novel approaches. We offer a summary of most evidence-based trials and scientific data on therapies for patients with ANOCA. This summary of available data about therapies aims to improve practitioners' knowledge and give more scientific merit to the care of patients with ANOCA.
尽管冠状动脉功能测试（CFT）技术在30多年前就已基本发展起来，但在具体诊断标准和内型方面仍缺乏共识。此外，对于大多数心脏病专家来说，非阻塞性冠状动脉性心绞痛（ANOCA）患者的管理具有挑战性。由于这些患者反复前往急诊室、多次进行冠状动脉造影，且即使在通过CFT正确诊断后心绞痛症状仍无改善，他们往往给医疗保健系统带来负担。针对冠状动脉微血管功能障碍、冠状动脉痉挛和心肌桥的治疗方法已在小型试验和少数随机对照试验中进行了测试。然而，我们能够为患者提供的治疗选择仍然有限。尽管CFT的技术和原理有了显著进步，但管理ANOCA患者的技巧仍然极具挑战性。需要对ANOCA的所有当代治疗选择进行专门的全面总结，以指导临床医生管理这一具有挑战性的患者群体。本文将ANOCA细分为3大类：冠状动脉微血管功能障碍、冠状动脉痉挛和心肌桥。ANOCA患者可能表现为所述类别中的一种或多种组合。我们描述了管理ANOCA患者的主要支柱：风险因素和生活方式改变、传统药物治疗、器械治疗和新方法。我们提供了关于ANOCA患者治疗的最具循证性的试验和科学数据的总结。这一关于治疗方法的可用数据总结旨在提高从业者的知识水平，并为ANOCA患者的护理提供更多科学依据。
