ArticleJournal of the American Heart Association2022
Clinical Relevance of Ischemia with Nonobstructive Coronary Arteries According to Coronary Microvascular Dysfunction.
Article in Journal of the American Heart Association, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it, 51 citations in OpenAlex.
- Myocardial Infarction with Non-Obstructive Coronary Arteries: A Puzzle in Search of a Solution.Reviews in cardiovascular medicine · 2022Pooled it
- The value of myocardial perfusion CZT-SPECT in the assessment of coronary microvascular dysfunction in INOCA patients: a comparative study with caIMR.The international journal of cardiovascular imaging · 2026Article
- Article
- Review
- Korean Society of Interventional Cardiology Expert Consensus for the Management of Chronic Coronary Syndrome: Part 2.Korean circulation journal · 2026Review
- The prognostic value of multiparameters derived from D-SPECT in patients with ANOCA.Annals of nuclear medicine · 2026Article
- A Pathophysiology-Oriented Imaging Phenotype Framework for Nonobstructive Coronary Artery Disease.Journal of cardiovascular development and disease · 2026Article
- Invasive Endotyping of Angina Pectoris with Nonobstructive Coronary Arteries.The International journal of angiology : official publication of the International College of Angiology, Inc · 2025Review
- Tailored treatment of specific diagnosis improves symptoms and quality of life in patients with myocardial Ischemia and Non-obstructive Coronary Arteries.Scientific reports · 2025Article
- The European Society of Cardiology 2024 Guidelines on Chronic Coronary Syndromes: A Critical Appraisal.Journal of clinical medicine · 2025Article
- ANOCA, INOCA, MINOCA: The New Frontier of Coronary Syndromes.Journal of cardiovascular development and disease · 2025Review
- Coronary Microvascular Dysfunction and Vasospastic Angina-Pathophysiology, Diagnosis and Management Strategies.Journal of clinical medicine · 2025Review
- Evaluation of right ventricular pacing-induced coronary microvascular dysfunction using guide wire-based sensor technology: a case report.European heart journal. Case reports · 2025Article
- Evolution of Coronary Microvascular Dysfunction Prevalence over Time and Across Diagnostic Modalities in Patients with ANOCA: A Systematic Review.Journal of clinical medicine · 2025Review
- Effect of sodium-glucose Co-transporter 2 inhibitors on coronary microcirculation.Frontiers in pharmacology · 2025Review
- Moderately Increased Left Ventricular Filling Pressure Suggesting Early Stage of Heart Failure with Preserved Ejection Fraction in Patients with Invasively Assessed Coronary Microvascular Dysfunction.Journal of clinical medicine · 2024Article
- The ANOCA/INOCA Dilemma Considering the 2024 ESC Guidelines on Chronic Coronary Syndromes.Journal of cardiovascular development and disease · 2024Article
- Prevalence of Coronary Microvascular Dysfunction and Epicardial Spasm in Patients With Angina and Myocardial Bridge.Journal of the Society for Cardiovascular Angiography & Interventions · 2024Article
- Prognostic Implications of Resistive Reserve Ratio in Patients With Nonobstructive Coronary Artery Disease With Myocardial Bridging.Journal of the American Heart Association · 2024Article
- Determining the Cause of Coronary Vasomotor Disorders in Patients With Ischemia and Nonobstructive Coronary Arteries: Design and Rationale of the DISCOVER INOCA Prospective, Multicenter Registry.Journal of the Society for Cardiovascular Angiography & Interventions · 2024Article
Corrections and comments
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Authors and funding
37 authors at 20 institutions in 8 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background In the absence of obstructive coronary stenoses, abnormality of noninvasive stress tests (NIT) in patients with chronic coronary syndromes may indicate myocardial ischemia of nonobstructive coronary arteries (INOCA). The differential prognosis of INOCA according to the presence of coronary microvascular dysfunction (CMD) and incremental prognostic value of CMD with intracoronary physiologic assessment on top of NIT information remains unknown. Methods and Results From the international multicenter registry of intracoronary physiologic assessment (ILIAS [Inclusive Invasive Physiological Assessment in Angina Syndromes] registry, N=2322), stable patients with NIT and nonobstructive coronary stenoses with fractional flow reserve >0.80 were selected. INOCA was diagnosed when patients showed positive NIT results. CMD was defined as coronary flow reserve ≤2.5. According to the presence of INOCA and CMD, patients were classified into 4 groups: group 1 (no INOCA nor CMD, n=116); group 2 (only CMD, n=90); group 3 (only INOCA, n=41); and group 4 (both INOCA and CMD, n=40). The primary outcome was major adverse cardiovascular events, a composite of all-cause death, target vessel myocardial infarction, or clinically driven target vessel revascularization at 5 years. Among 287 patients with nonobstructive coronary stenoses (fractional flow reserve=0.91±0.06), 81 patients (38.2%) were diagnosed with INOCA based on positive NIT. By intracoronary physiologic assessment, 130 patients (45.3%) had CMD. Regardless of the presence of INOCA, patients with CMD showed a significantly lower coronary flow reserve and higher hyperemic microvascular resistance compared with patients without CMD (
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