Non-obstructive Plaque and Treatment of INOCA: More to Be Learned

Purpose of Review A significant proportion of patients evaluated for chest pain have ischemia with non-obstructive coronary artery disease (INOCA). Studies have shown INOCA is associated with increased risk of major adverse cardiac events and significant burden on the health care system. Recent Findings While there is scarce scientific evidence on management of INOCA, the CorMicA trial showed that stratified medical therapy based on the type of INOCA improved patients' symptoms and quality of life. There are multiple ongoing trials, including Women's IschemiA Trial to Reduce Events in Non-ObstRuctIve CORonary Artery Disease (WARRIOR trial), assessing the benefit of intensive medical therapy versus usual care for this increasingly recognized clinical entity. In this review, we discuss the definition of INOCA, epidemiology and risk factors, pathophysiology, and management as well as the current knowledge gaps and ongoing clinical trials in this arena.

Automated summary

This article discusses the definition, epidemiology and risk factors, pathophysiology, management, and current knowledge gaps and ongoing clinical trials of patients with ischemia with non-obstructive coronary artery disease (INOCA). Studies have shown that INOCA is associated with increased risk of major adverse cardiac events and significant burden on the health care system. The recent CorMicA trial showed that stratified medical therapy based on the type of INOCA improved patients' symptoms and quality of life.