We have a greater understanding of ‘cardiac syndrome X,’ but questions remain

[摘要] There was a time when diagnosing coronary artery disease and managing its clinical expression of angina and myocardial infarction focused almost entirely on the lumens of the major coronary vessels. Culprit stenoses needed to be recognized and rectified, mainly via bypass or an endovascular procedure. Medical therapy was adjunctive or preventative. Improved understanding of the biologic nature of the stenosing plaque and proliferating and remodeling vascular tissue led to the implementation of still-evolving approaches directed at plaque stabilization and shrinkage, as well as antithrombotic and antiproliferative therapies. We also saw that some patients experienced classic angina with imaging or electrocardiographic evidence of myocardial ischemia and sometimes infarction in the absence of significant epicardial coronary artery obstructive lesions. The pathogenesis was unclear, and these patients were thus diagnosed as having “cardiac syndrome X.” In current parlance, they have ischemia and no obstructive coronary artery disease (INOCA). Greater understanding of this condition, which can clinically mirror obstructive coronary artery disease (CAD) until coronary angiography is performed, has led to the recognition that many of these patients have coronary microvascular dysfunction (CMD).

[学科分类] 卫生学