Intern Med. 2026 May 23. doi: 10.2169/internalmedicine.7337-26. Online ahead of print.
ABSTRACT
The management of ischemic heart disease has traditionally focused on obstructive epicardial coronary artery disease. However, a substantial proportion of patients with angina and objective myocardial ischemia have no significant coronary stenosis. Vasospastic angina (VSA; also termed coronary spastic angina [CSA] ) and coronary microvascular dysfunction (CMD) are now recognized as major mechanisms underlying angina/ischemia with non-obstructive coronary arteries (ANOCA/INOCA). These evolving concepts have been progressively incorporated into the clinical practice guidelines. Japanese guidelines have played a pioneering role in establishing diagnostic criteria for VSA through coronary spasm provocation testing. More recently, international guidelines have emphasized CMD as a distinct clinical entity and recommended coronary functional assessment using both invasive and non-invasive modalities. This review summarizes the historical evolution of the guideline-based perspectives on VSA and CMD and discusses their implications for contemporary clinical practice.
PMID:42178266 | DOI:10.2169/internalmedicine.7337-26