Management of ischaemia with non-obstructive coronary arteries (INOCA)
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj-2021-060602 (Published 26 November 2021) Cite this as: BMJ 2021;375:e060602
- John F Beltrame, professor1 2 3,
- Rosanna Tavella, associate professor1 2 3,
- Dione Jones, doctor1 2,
- Chris Zeitz, associate professor1 2 3
- 1Adelaide Medical School, University of Adelaide, Queen Elizabeth Hospital Campus, Woodville South, Adelaide, SA, Australia
- 2Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- 3Basil Hetzel Institute for Translational Health Research, Queen Elizabeth Hospital, Woodville South, Adelaide, SA, Australia
- Correspondence to: J F Beltrame john.beltrame{at}adelaide.edu.au
Abstract
Up to half of patients undergoing elective coronary angiography for the investigation of chest pain do not present with evidence of obstructive coronary artery disease. These patients are often discharged with a diagnosis of non-cardiac chest pain, yet many could have an ischaemic basis for their symptoms. This type of ischaemic chest pain in the absence of obstructive coronary artery disease is referred to as INOCA (ischaemia with non-obstructive coronary arteries). This comprehensive review of INOCA management looks at why these patients require treatment, who requires treatment based on diagnostic evaluation, what clinical treatment targets should be considered, how to treat patients using a personalised medicine approach, when to initiate treatment, and where future research is progressing.
Footnotes
Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors.
Contributors: DJ, RT, CZ, and JB conducted a review of the literature and prepared the manuscript draft. All authors were substantially involved in the conception, drafting, and editing of the manuscript. All authors have given final approval of the manuscript and are accountable for all portions of the manuscript. JB is the guarantor.
Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: none.
Provenance and peer review: Commissioned; externally peer reviewed.
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