Consensus of European Experts on the Management of Patients with Ischemia with Non-Obstructive Coronary Arteries with Chronic Coronary Syndrome: Possibilities for Use in Outpatient Clinical Practice in Russia

In 2020, a consensus document of the European Society of Cardiology on the management of patients with myocardial ischemia with non-obstructive coronary arteries was released. The main provisions of the new document are aimed at identifying a special group of patients with chronic coronary syndrome and suspected vasospastic or microvascular angina in order to rationalize and personalize the approach to their management. Most patients with established myocardial ischemia do not have obstructive coronary arteries when undergoing coronary angiography. Coronary microvascular dysfunction and epicardial vasospasm, alone or in combination with obstructive coronary artery atherosclerosis, are the causes of myocardial ischemia. In this case, microvascular dysfunction is considered as a significant provoking factor in the pathogenesis of refractory angina pectoris. Diagnosis of such conditions is often difficult, and therefore the correct therapy is not prescribed for such patients. As a consequence, these patients have a poor quality of life, which leads to hospital readmissions, poor cardiovascular outcomes in the short and long term, and a significant burden on health care resources. The article discusses the possibilities of applying new recommendations and consensus in the diagnosis and management of such patients in outpatient clinical practice in Russia. At the initial stages of diagnosis, priority is given to non-invasive research methods; in-depth examination, carried out using invasive methods with a pharmacological testing. Patient management uses a stepwise strategy depending on the specific clinical situation. Calcium channel blockers or beta blockers remain the first line anti-ischemic therapy.