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Coronary Microvascular Dysfunction in Patients with Non-Obstructive Coronary Arteries: Current Gaps and Future Directions

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Abstract

There has been increasing interest in open artery syndrome, also known as ischemia with non-obstructive coronary arteries (INOCA). INOCA has been increasingly recognized as a heterogeneous clinical entity. Diagnostic evaluation of this heterogeneous entity, including invasive assessment, remains key to diagnose this clinical condition and provide the appropriate treatment. Importantly, medical stratification based on the type of INOCA has shown benefit in improving the symptoms in these patients, as illustrated in the CorMicA trial. The Women’s IschemiA Trial to Reduce Events in Non-ObstRuctIve CORonary Artery Disease (WARRIOR) is another promising landmark trial that is currently enrolling patients and will address some of the unanswered questions for management of women with INOCA. In this review, we discuss the pathophysiology, management options, knowledge gaps, and future directions while highlighting the rationale and design of the ongoing WARRIOR trial.

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Author notes

  1. Islam Y. Elgendy and Lina Ya’Qoub equally contributed as first co-authors.

Authors and Affiliations

  1. Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

    Islam Y. Elgendy & Kuan-Han Chen

  2. Department of Interventional Cardiology, Henry Ford Hospital, Detroit, MI, USA

    Lina Ya’Qoub

  3. Division of Cardiovascular Medicine, University of Florida, 1329 SW 16th St, PO Box 100288, Gainesville, FL, 32610, USA

    Carl J. Pepine

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  1. Islam Y. Elgendy
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  2. Lina Ya’Qoub
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  3. Kuan-Han Chen
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  4. Carl J. Pepine
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Correspondence to Carl J. Pepine.

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No external funding was used in the preparation of this manuscript.

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Unrelated to this manuscript content, Dr. Elgendy has received research grants from Caladrius Biosciences, Inc. Drs Ya’Qoub, Chen and Pepine declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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IYE performed the literature search, reviewed the data, wrote and edited the manuscript. LY performed the literature search, reviewed the data, wrote and edited the manuscript. KHC performed the literature search and wrote part of the manuscript. CJP reviewed the data and edited the manuscript.

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Elgendy, I.Y., Ya’Qoub, L., Chen, KH. et al. Coronary Microvascular Dysfunction in Patients with Non-Obstructive Coronary Arteries: Current Gaps and Future Directions. Drugs 82, 241–250 (2022). https://doi.org/10.1007/s40265-021-01667-y

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