The recently published European Association of Percutaneous Cardiovascular Interventions (EAPCI) Expert Consensus Document defines INOCA and guidance to its diagnosis and management.1
ESC guidelines recommend measuring coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) using a guidewire-based approach.2
EAPCI Consensus Document on INOCA
Alaide Chieffo MD, Milan, Italy
Kunadian et al. European Heart Journal. 2020; 0:1-21.
An updated standardization of CMD criteria is provided by the COVADIS group including the cut-off values of CFR<2.0 and IMR≥25 that characterize CMD.1
Kunadian et al. European Heart Journal. 2020; 0:1-21.
The microcirculation carries far more myocardial blood volume compared to the epicardial arteries. CMD can be defined as impaired CFR in the absence of epicardial obstructive CAD—i.e., downstream vasomotor dysfunction.3
Patients with INOCA, including those diagnosed with CMD, have an increase in major adverse cardiac events (MACE) including:
Coronary Flow Reserve Associated with MACE Risks3
Image adapted from Taqueti et al, J Am Coll Cardiol 20183
The clinical spectrum of CMD may be characterized by three factors:3
Clinical Spectrum of CMD
Image adapted from Taqueti et al, J Am Coll Cardiol 20183
INOCA frequently impacts patient quality of life (QOL) and consumes significant health care expenditures.5,6 With multiple evaluations and frequent hospitalization5,6, each additional hospitalization can add $2,100 (the Netherlands) to $7,300 (the U.S.) in healthcare costs.7
Nevertheless, it is possible to accurately diagnose patients on their first visit to the cath lab and to provide effective treatment.
The PressureWire™ X Guidewire and Coroventis‡ CoroFlow‡ Cardiovascular System can measure both IMR and CFR - allowing for a CMD diagnosis.8
Image adapted from Lee et al, J Am Coll Cardiol 20155
Having a comprehensive physiology testing of both the epicardial arteries and microcirculation can provide clear diagnosis to guide treatment and outcomes.5
Microvascular angina and vasospastic angina are the two most common causes of INOCA, and both types of angina can be identified with diagnostic testing. The randomized CorMicA trial provides a diagnostic and treatment approach.9
The trial protocol assessed patients to determine:
CorMicA Findings
Colin Berry MD, PhD, Glasgow, UK
CorMicA Trial: 1-Year RCT Outcomes9
The CorMicA results indicate a role for a more thorough investigation of coronary microvascular dysfunction among patients with INOCA, as well as an opportunity to better tailor patient treatment.9
INOCA is not benign and associated with under-diagnosis, under-treatment and poor prognosis. The EAPCI Expert Consensus Document defines INOCA and provides guidance to the clinical community on the diagnostic approach and management of INOCA based on existing evidence and best current practices.1
Kunadian et al. European Heart Journal. 2020; 0:1-21.
angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB)
MAT-2112674 v1.0
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Unless otherwise specified, all product and service names appearing in this Internet site are trademarks owned by or licensed to Abbott, its subsidiaries or affiliates. No use of any Abbott trademark, trade name, or trade dress in this site may be made without the prior written authorization of Abbott, except to identify the product or services of the company.
