Nonobstructive epicardial coronary artery disease: an evolving concept in need of diagnostic and therapeutic guidance.

Postgraduate medicine Pub Date : 2024-05-01 Epub Date: 2024-05-31 DOI:10.1080/00325481.2024.2360888
Angel Lopez-Candales, Khalid Sawalha, Talal Asif
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Abstract

For decades, we have been treating patients presenting with angina and concerning electrocardiographic changes indicative of ischemia or injury, in whom no culprit epicardial coronary stenosis was found during diagnostic coronary angiography. Unfortunately, the clinical outcomes of these patients were not better than those with recognized obstructive coronary disease. Improvements in technology have allowed us to better characterize these patients. Consequently, an increasing number of patients with ischemia and no obstructive coronary artery disease (INOCA) or myocardial infarction in the absence of coronary artery disease (MINOCA) have now gained formal recognition and are more commonly encountered in clinical practice. Although both entities might share functional similarities at their core, they pose significant diagnostic and therapeutic challenges. Unless we become more proficient in identifying these patients, particularly those at higher risk, morbidity and mortality outcomes will not improve. Though this field remains in constant flux, data continue to become available. Therefore, we thought it would be useful to highlight important milestones that have been recognized so we can all learn about these clinical entities. Despite all the progress made regarding INOCA and MINOCA, many important knowledge gaps continue to exist. For the time being, prompt identification and early diagnosis remain crucial in managing these patients. Even though we are still not clear whether intensive medical therapy alters clinical outcomes, we remain vigilant and wait for more data.

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非阻塞性心外膜冠状动脉疾病:一个需要诊断和治疗指导的不断发展的概念。
几十年来,我们一直在治疗那些出现心绞痛、心电图变化提示缺血或损伤的患者,但在诊断性冠状动脉造影术中并未发现心外膜冠状动脉狭窄的罪魁祸首。遗憾的是,这些患者的临床疗效并不比那些已被确认患有阻塞性冠状动脉疾病的患者好。技术的进步使我们能够更好地描述这些患者的特征。因此,越来越多的缺血且无阻塞性冠状动脉疾病(INOCA)或无冠状动脉疾病的心肌梗死(MINOCA)患者现已得到正式承认,并在临床实践中更为常见。尽管这两种疾病在核心功能上可能有相似之处,但它们在诊断和治疗上都提出了巨大的挑战。除非我们能更熟练地识别这些患者,尤其是高危患者,否则发病率和死亡率都不会改善。尽管这一领域仍在不断变化,但数据仍在不断涌现。因此,我们认为有必要重点介绍已被确认的重要里程碑,以便我们都能了解这些临床实体。尽管在 INOCA 和 MINOCA 方面取得了诸多进展,但仍存在许多重要的知识空白。就目前而言,及时识别和早期诊断仍然是管理这些患者的关键。尽管我们仍不清楚强化医学治疗是否会改变临床结果,但我们仍会保持警惕,等待更多的数据。
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