ANOCA/INOCA/MINOCA: Open Artery Ischemia

Ischemic heart disease continues to represent a major health threat for death, disability, and poor quality of life as it also consumes enormous health-related resources. For over a century, the major was taken to be involving the larger coronary arteries (e.g., coronary artery disease [CAD]). However, evolving evidence now indicates that is the predominant phenotype. Patients within this phenotype have been termed to have angina with no obstructive CAD (ANOCA), ischemia with no obstructive CAD (INOCA), or myocardial infarction with no obstructive coronary arteries (MINOCA). But as methods to assess cardiomyocyte injury evolve, these phenotypic distinctions have begun to merge, raising concern about their usefulness. Also, considerable evidence has suggested . These include (failure to relax appropriately, exaggerated constriction ["spasm"], etc.), , , hypercoagulable states, and several others, or . This review summarizes these syndromes and their associated clinical outcomes with an emphasis on potential mechanistic signals. These involve the endothelium, the microvasculature, and cardiomyocyte function. Biomarkers of involving these structures are discussed along with a being tested in an ongoing trial.