An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group

Author:

Kunadian Vijay1ORCID,Chieffo Alaide2,Camici Paolo G3,Berry Colin4ORCID,Escaned Javier5ORCID,Maas Angela H E M6ORCID,Prescott Eva7,Karam Nicole8ORCID,Appelman Yolande9,Fraccaro Chiara10ORCID,Louise Buchanan Gill11,Manzo-Silberman Stephane12,Al-Lamee Rasha13ORCID,Regar Evelyn14,Lansky Alexandra1516ORCID,Abbott J Dawn17ORCID,Badimon Lina18ORCID,Duncker Dirk J19ORCID,Mehran Roxana20,Capodanno Davide21,Baumbach Andreas2223ORCID

Affiliation:

1. Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, M4:146 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK

2. IRCCS San Raffaele Scientific Institute, Milan, Italy

3. Vita Salute University and San Raffaele Hospital, Milan, Italy

4. British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK

5. Hospital Clinico San Carlos IDISSC, Complutense University, Madrid, Spain

6. Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands

7. Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark

8. European Hospital Georges Pompidou (Cardiology Department), Paris University and Paris Cardiovascular Research Center (INSERMU970), Paris, France

9. Department of Cardiology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, the Netherlands

10. Department of Cardiac, Thoracic and Vascular Science and Public Health, Padova, Italy

11. North Cumbria Integrated Care NHS Foundation Trust, Cumbria, UK

12. Department of Cardiology, Lariboisière Hospital Paris University, Paris, France

13. National Heart and Lung Institute, Imperial College London, London, UK

14. Ludwig-Maximilians-University, Munich, Germany

15. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA

16. Bart’s Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK

17. Lifespan Cardiovascular Institute and Warren Alpert Medical School of Brown University, Providence, RI, USA

18. Cardiovascular Program-ICCC, IR-Hospital de la Santa Creu i Sant Pau, CiberCV, Barcelona, Spain

19. Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

20. Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA

21. CardioThoracic-Vascular and Transplant Department, A.O.U. ‘Policlinico-Vittorio Emanuele’, University of Catania, Catania, Italy

22. Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK

23. Yale University School of Medicine, New Haven, CT, USA

Abstract

Abstract This consensus document, a summary of the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), appraises the importance of ischaemia with non-obstructive coronary arteries (INOCA). Angina pectoris affects approximately 112 million people globally. Up to 70% of patients undergoing invasive angiography do not have obstructive coronary artery disease, more common in women than in men, and a large proportion have INOCA as a cause of their symptoms. INOCA patients present with a wide spectrum of symptoms and signs that are often misdiagnosed as non-cardiac leading to under-diagnosis/investigation and under-treatment. INOCA can result from heterogeneous mechanism including coronary vasospasm and microvascular dysfunction and is not a benign condition. Compared to asymptomatic individuals, INOCA is associated with increased incidence of cardiovascular events, repeated hospital admissions, as well as impaired quality of life and associated increased health care costs. This consensus document provides a definition of INOCA and guidance to the community on the diagnostic approach and management of INOCA based on existing evidence from research and best available clinical practice; noting gaps in knowledge and potential areas for further investigation.

Funder

British Heart Foundation

Medical Research Council

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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