Debate: Ischemia without obstructive coronary artery disease. An invasive coronary physiological macro- and microvascular assessment is necessary

Abstract

QUESTION: Could tell us what the prevalence of angina without obstructive coronary artery disease is in patients referred for invasive angiography and how has it evolved over the last few years? ANSWER: Nearly half of the patients referred for cardiac catheterization due to suspected stable angina have coronary arteries without obstructive lesions.1 These numbers are even higher in the series of patients studied through cardiac computed tomography to the point that up to 3 out of 4 patients do not show any obstructive lesions. Women have a higher prevalence compared to men of up to 70%. Therefore, angina without obstructive lesions should not be considered a secondary problem, but a fundamental aspect of our routine clinical practice at the cath lab. Also, these patients have high rates of recurring angina and disability,2 which means that achieving the proper diagnosis and administering the right treatment is of paramount importance. Q.: We have been using the expression «without obstructive coronary artery disease», but it can be put into context. Shouldn’t we rather say «without angiographically significant stenoses». Do you think that the physiological significance of stenoses with guidewire pressure should always be excluded, even the mild ones? A.: With the evidence available, I believe that...