52
Figure 14. Clinical Decision Pathway for INOCA
Treatment
Stable Chest Pain
Suspected INOCA
Invasive coronary function testing*
(requires nonobstructive CAD FFR ≥0.8)
(2a)
CFR ≥2.0
+
IMR <25
+
negative
provocative
study to ACh
CMD
Vasospasm
†
Noncardiac
Epicardial artery
spasm (>90%)
with ACh
+
reproduction of
chest pain
+
ischemic ECG
changes
IMR ≥25
OR
CFR <2.0
OR
angina with
ST depression
during ACh bolus
or infusion, and
epicardial artery
constriction
Intensification of preventive strategies + symptom guided GDMT (1)
Noninvasive testing
more prevalent Invasive
assessment more
comprehensive
