Non-obstructive plaque and INOCA treatments: a review
Ischaemia with no obstructive coronary arteries, INOCA, can be defined by the following criteria: (1) stable, long-lasting symptoms that include angina, (2) evidence of myocardial ischemia through ECG or cardiac imaging, both at rest or during physical/mental stress, and (3) an absence of flow-limiting obstruction, as demonstrated by coronary angiography. The underlying causes and mechanisms for this condition are multifactorial, so it is vital that INOCA management is patient-centred to focus on all different sub-types and experiences. Multidisciplinary management involving medication and lifestyle changes should be implemented. Types of medication used to INOCA treatment vary; there have been numerous studies, including using betablockers, angiotensin receptor blockers and ranolazine. Non-conventional treatments for INOCA have included exercise regimes, tricyclic anti-depressants and spinal cord stimulation. However, there is a lack of evidence to understand the optimal medical therapy for patients with INOCA. Currently, the Women’s Ischemia Trial to Reduce Events in Non-Obstructive Coronary Artery Disease (WARRIOR trial) is attempting to understand the ideal medical therapy for INOCA.
This review by Ya-Qoub L et al. aimed to define INOCA, as well as its mechanisms, current management regimes and knowledge gaps.
Key learnings
There is a vital need to understand the optimal medical therapy for INOCA, which the WARRIOR trial is currently working towards. Allowing for a multidisciplinary, patient-centred approach will allow for the best, individualised management regimes for INOCA patients.