The Lancet / EuroPCR 2026
ANOCA, INOCA & MINOCA: Beyond a “Normal” Angiogram
* ANOCA: Angina with Non-Obstructive Coronary Arteries (chest pain with non-obstructive coronaries, with or without objective evidence of ischemia).
* INOCA: Angina with Objective evidence of myocardial ischemia with Non-Obstructive Coronary Arteries (Stress ECG, Stress Echo, Nuclear Imaging, PET, CMR, etc.)
INOCA = ANOCA + objective evidence of ischemia.
* MINOCA: Myocardial Infarction with Non-Obstructive Coronary Arteries.
* Common mechanisms include Coronary Microvascular Dysfunction (CMD), epicardial coronary spasm, and microvascular spasm.
Study Findings
* Prospective multicenter study of 1,003 patients undergoing clinically indicated coronary angiography and coronary physiology assessment.
* CMD was associated with a 91% higher risk of MACE.
* In patients without obstructive CAD, MACE occurred in 31% with CMD vs 9% without CMD (HR 3.45).
Take-Home Message
A normal angiogram does not exclude significant cardiovascular risk. CMD and coronary spasm are important causes of ANOCA/INOCA and are associated with adverse cardiovascular outcomes.
Source: The Lancet, presented at EuroPCR 2026 ؛ Medscape, June 5, 2026.
