Isquemia miocárdica sem lesões coronarianas obstrutivas (INOCA): o que é preciso saber?

Abstract

Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality worldwide. An emerging phenomenon related to CAD is myocardial ischemia without obstructive coronary lesions (INOCA), which is characterized by myocardial ischemia in the absence of significant obstructions, leading to anginal symptoms but without evidence of obstructive arterial disease. INOCA, initially considered a benign condition, is now recognized as a risk factor for myocardial infarction and heart failure with preserved ejection fraction, with a significant impact on patients' quality of life and health care costs. Its pathophysiology is not yet fully understood, but it involves microvascular dysfunction and/or spasms of the coronary vessels. Invasive and noninvasive techniques can be used for its diagnosis, such as coronary angiography and functional tests that assess coronary flow reserve and microvascular dysfunction. Correct diagnosis and classification of INOCA subtypes are crucial for management, which should include lifestyle changes and pharmacological treatment targeting the identified phenotypes. This study aims to review the literature on INOCA, addressing its clinical characteristics, causes, diagnoses and therapeutic options, in addition to exploring future perspectives in this field of study.