1. ANOCA: From Angina to Diagnosis and Tailored Treatment
1. ANOCA: From Angina to Diagnosis and Tailored Treatment
Non-Obstructive Coronary Syndromes — Part 1
Sources: Featured in TCTMD — August 4, 2026; TRI-NOCA Study — EuroIntervention, July 2026; ESC Chronic Coronary Syndromes Guidelines, 2024.
Key Points
* Patient presents with typical/recurrent angina → assess cardiovascular risk and exclude other causes of chest pain.
* Evaluate for coronary artery disease (CAD) with appropriate non-invasive testing and/or coronary angiography.
* Coronary angiography shows no significant obstructive CAD → consider ANOCA (Angina with Non-Obstructive Coronary Arteries) rather than automatically labeling the symptoms as “non-cardiac.”
* Look for objective evidence of ischemia, when appropriate, using stress echo, PET/SPECT, or stress Cardiac Magnetic Resonance (CMR). If ischemia is demonstrated without obstructive CAD → INOCA (Ischemia with Non-Obstructive Coronary Arteries).
* A = Angina → symptom
* I = Ischemia → objective evidence
* If symptoms persist or the mechanism remains unclear → invasive coronary functional testing, ideally during the same angiographic procedure when available:
* Adenosine → assesses Coronary Flow Reserve (CFR), the ability of coronary blood flow to increase when needed, and Index of Microcirculatory Resistance (IMR), the resistance within the coronary microcirculation. Abnormal results can identify Coronary Microvascular Dysfunction (CMD).
* Acetylcholine → identifies epicardial coronary spasm or microvascular spasm.
* MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) is a different clinical presentation: myocardial infarction without significant obstructive CAD.
Simply:
ANOCA = Angina → INOCA = Ischemia → MINOCA = Myocardial Infarction, all in the setting of non- obstructive coronary arteries.
https://www.tctmd.com/news/anoca-endotyping-bolsters-qol-real-world-data-confirm
