Key result
Angina and ischemia with non-obstructive coronary arteries require exclusion of flow-limiting disease and assessment of coronary vasomotor endotypes for management (narrative review; no numeric data).
Why the study?
Angina with non-obstructive coronary arteries (ANOCA) is an increasingly recognized syndrome, and its ischemic subset (INOCA) is associated with impaired quality of life and increased risks of heart failure, major adverse cardiovascular events, and mortality, particularly among women.
This review summarizes the epidemiology, pathophysiology, diagnostic evaluation, and endotype-guided management of angina and ischemia with non-obstructive coronary arteries (ANOCA/INOCA).
Highlights need for INOCA recognition in angina evaluation, especially among women; leaves open targeted therapeutic trials.
Angina with non-obstructive coronary arteries (ANOCA) is an increasingly recognized clinical syndrome characterized by angina or angina-equivalent symptoms in the absence of obstructive coronary artery disease. Ischemia with non-obstructive coronary arteries (INOCA) is a subset in which objective evidence of ischemia is demonstrated. INOCA is associated with impaired quality of life and increased risk of heart failure, major adverse cardiovascular events, and mortality, particularly among women. The primary mechanisms include coronary microvascular dysfunction and vasospastic angina. Diagnosis requires exclusion of flow-limiting coronary disease and, when available, assessment for underlying coronary vasomotor endotypes. This review summarizes the current understanding of the epidemiology, pathophysiology, diagnostic evaluation, and management of ANOCA, including INOCA where objective ischemia is demonstrated.
No takes yet. Share an insight, caveat, or question.
Reddy et al. (2026) conducted a review in Angina with non-obstructive coronary arteries (ANOCA) and ischemia with non-obstructive coronary arteries (INOCA). Diagnostic evaluation and endotype-guided management was evaluated. Angina and ischemia with non-obstructive coronary arteries require exclusion of flow-limiting disease and assessment of coronary vasomotor endotypes for management (narrative review; no numeric data).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: