INOCA – Ischemia and No Obstructive Coronary Artery Disease

INOCA – Ischemia and No Obstructive Coronary Artery Disease

INOCA is the acronym for Ischemia and No Obstructive Coronary Artery Disease [1]. They have elevated risk for cardiovascular events like acute coronary syndrome and hospitalization for heart failure. Risk of development of heart failure with preserved ejection fraction (HFpEF) is also higher in these subjects. Some of them have coronary microvascular dysfunction and evidence of inflammation.

In spite of the absence of obstructive coronary arteries, they have a risk of repeated hospitalizations and repeated coronary angiographies, involving significant health care costs. In general, INOCA is more common in females. They tend to have coronary microvascular dysfunction, plaque erosion and thrombus formation [2]. They may have more extensive non obstructive coronary artery disease and have associated hypertension and diabetes mellitus. Major adverse events are similar to those with obstructive coronary artery disease.

Reference

  1. Bairey Merz CN, Pepine CJ, Walsh MN, Fleg JL. Ischemia and No Obstructive Coronary Artery Disease (INOCA): Developing Evidence-Based Therapies and Research Agenda for the Next Decade. Circulation. 2017 Mar 14;135(11):1075-1092.
  2. Pepine CJ, Ferdinand KC, Shaw LJ, Light-McGroary KA, Shah RU, Gulati M, Duvernoy C, Walsh MN, Bairey Merz CN; ACC CVD in Women Committee. Emergence of Nonobstructive Coronary Artery Disease: A Woman’s Problem and Need for Change in Definition on Angiography. J Am Coll Cardiol. 2015 Oct 27;66(17):1918-33.