Why the study?
Although ischemic heart disease management traditionally focused on obstructive epicardial disease, vasospastic angina and coronary microvascular dysfunction are now recognized as major causes of ANOCA/INOCA and have been progressively incorporated into clinical practice guidelines.
This review highlights the historical evolution of clinical guidelines in recognizing vasospastic angina and coronary microvascular dysfunction as distinct, treatable causes of myocardial ischemia.
Supports functional coronary assessment in ANOCA; extends guideline history while leaving optimal management open.
The management of ischemic heart disease has traditionally focused on obstructive epicardial coronary artery disease. However, a substantial proportion of patients with angina and objective myocardial ischemia have no significant coronary stenosis. Vasospastic angina (VSA; also termed coronary spastic angina [CSA] ) and coronary microvascular dysfunction (CMD) are now recognized as major mechanisms underlying angina/ischemia with non-obstructive coronary arteries (ANOCA/INOCA). These evolving concepts have been progressively incorporated into the clinical practice guidelines. Japanese guidelines have played a pioneering role in establishing diagnostic criteria for VSA through coronary spasm provocation testing. More recently, international guidelines have emphasized CMD as a distinct clinical entity and recommended coronary functional assessment using both invasive and non-invasive modalities. This review summarizes the historical evolution of the guideline-based perspectives on VSA and CMD and discusses their implications for contemporary clinical practice.
No takes yet. Share an insight, caveat, or question.
Hokimoto et al. (2026) conducted a review in Vasospastic angina and coronary microvascular dysfunction. Clinical guidelines have progressively incorporated vasospastic angina and coronary microvascular dysfunction as major mechanisms underlying angina with non-obstructive coronary arteries.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: