Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Herscovici, Romana; Sedlak, Tara; Wei, Janet; Pepine, Carl J.; Handberg, Eileen M.; Merz, C. Noel Bairey

doi:10.1161/jaha.118.008868

Cited by 140 publications

(103 citation statements)

References 86 publications

(141 reference statements)

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“…However, a recent large study demonstrated that clinical outcomes were similar between patients with MINOCA and those with OCAD MI [14]. Data on patients with ACS INOCA patients are limited but there is emerging evidence that patients with INOCA are at a higher risk of future adverse clinical events, including death, MI, stroke, or heart failure, than was previously believed [10].…”

Section: Introductionmentioning

confidence: 98%

“…Patients with MINOCA are usually younger and more often females; however, the distribution of the traditional cardiovascular risk factors and comorbidities varies between analyses [5,[7][8][9]. Data on clinical profiles of patients with INOCA presenting with ACS are scarce [3,10]. Atherosclerosis is considered an important mediator of both INOCA and MINOCA syndromes [3], and ruptured atherosclerotic plaques appear on coronary imaging in approximately 40% of these patients [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Clinical presentation and 3-year outcomes of patients with acute coronary syndromes and non-obstructive coronary arteries on angiography

et al. 2020

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Background With the emerging interest in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA), there is a need to define an even broader group of patients with the syndrome of myocardial ischemia with non-obstructive coronary arteries (INOCA). There are limited data on the clinical characteristics and prognoses of such patients who present with symptoms of acute coronary syndrome (ACS) and undergo urgent coronary angiography that reveals no significant lesions. The aim of this observational study was to compare patients with ACS INOCA and those with ACS with obstructive coronary artery disease (OCAD) both within unadjusted cohorts and with propensity score matched controls. Methods and results This observational study was based on the data from the Polish National Registry of Invasive Cardiology Procedures. Of 9744 patients included, 7624 had OCAD and 2120 had ACS INOCA. In unadjusted cohorts, the overall survival and incidence of major adverse cardiovascular events (MACE: death, cardiac arrest, myocardial infarction, stroke, and heart failure hospitalization) until 36 months were higher in patients with ACS OCAD. Following propensity matching, higher win ratios of death (p = 0.02), additional revascularizations by percutaneous coronary intervention or coronary artery bypass graft surgery (p<0.001), and cardiac hospitalization (p<0.001) were observed in these patients. In contrast, the win ratios of myocardial infarction (p = 0.74), heart failure hospitalization (p = 0.86), and MACE (p = 0.07) were not significantly different between the groups. Conclusions The prognosis of patients with ACS INOCA was more favorable than that of patients with ACS OCAD; however, the differences diminished after adjustments for the initial clinical

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Clinical presentation and 3-year outcomes of patients with acute coronary syndromes and non-obstructive coronary arteries on angiography

et al. 2020

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“…With improvements in cardiac testing over time that are now sensitive to microvascular as well as macrovascular CAD, however, these patients are now increasingly referred to as patients with ischaemia and no obstructive coronary artery disease (INOCA;Herscovici et al, 2018). For psychological stress to be considered a plausible factor in explaining higher CAD event rates in patients with INOCA, it is important to determine whether psychological stress is associated with clinical symptoms and established CAD risk factors.…”

Section: Introductionmentioning

confidence: 99%

Psychological stress, cardiac symptoms, and cardiovascular risk in women with suspected ischaemia but no obstructive coronary disease

Gomez

Merz

Eastwood³

et al. 2020

Stress and Health

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This paper evaluated cross‐sectional relationships between psychological stress and coronary artery disease (CAD) risk among women with suspected ischaemia and no obstructive coronary artery disease (INOCA). Between 1996 and 2000, 551 women with INOCA were enrolled in the Women's Ischemia Syndrome Evaluation (WISE) cohort from four U.S. institutions. Between 2009 and 2012, 376 women with INOCA were recruited from two U.S. institutions for an independent cohort study titled WISE‐Coronary Vascular Dysfunction (WISE‐CVD). Participants underwent coronary angiography and testing for CAD symptoms and risk factors at baseline. Psychological stress was assessed in the form of home/work stress in WISE and home/work stress and financial stress in WISE‐CVD. Results showed that home/work stress predicted greater depression, functional impairment, CAD symptoms, and lower self‐rated health in WISE but was inconsistent as a predictor in WISE‐CVD. In contrast, >60% of WISE‐CVD women reported moderate or severe financial stress. Financial stress levels predicted more CAD risk factors and cardiac symptoms, poorer self‐rated health, and greater depression and functional impairment. Among women with INOCA, psychological stress was associated with CAD symptoms and CAD risk factors. The prevalence and predictive value of psychological stress in this population supports the inclusion of stress measures in future CAD research.

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“…First of all, MPI is only able to demonstrate the presence of hemodynamically significant coronary lesions, unable to detect non-obstructive or diffuse coronary atherosclerosis, which can have an adverse prognostic impact, and deserve the implementation of preventive strategies. 8 On the other hand, conventional MPI shows an inadequate accuracy in conditions characterized by a diffuse alteration of myocardial perfusion, such as in the case of multivessel CAD causing balanced ischemia, or CAD with superimposed endothelial/microvascular dysfunction due to cardiovascular risk factors.…”

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confidence: 99%

Dynamic ultrafast CZT imaging: Time for a paradigm change in myocardial perfusion imaging

Liga

Gimelli

2021

Journal of Nuclear Cardiology

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Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Cited by 140 publications

References 86 publications

Clinical presentation and 3-year outcomes of patients with acute coronary syndromes and non-obstructive coronary arteries on angiography

Clinical presentation and 3-year outcomes of patients with acute coronary syndromes and non-obstructive coronary arteries on angiography

Psychological stress, cardiac symptoms, and cardiovascular risk in women with suspected ischaemia but no obstructive coronary disease

Dynamic ultrafast CZT imaging: Time for a paradigm change in myocardial perfusion imaging

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