Chest pain with normal coronary arteries: Future directions

Abstract

A significant proportion of symptomatic patients (e.g. angina) with suspected chronic ischemic coronary syndromes presenting to coronary angiography have no obstructive coronary artery disease (CAD). These patients most often receive no specific therapy and are dismissed from sub-specialty care. Epidemiological and clinical evidence demonstrates that a subgroup of these patients are at higher risk of adverse cardiac events and poor quality of life. Available evidence now exists that identifies elevated risk as well as mechanistic pathways of coronary vascular dysfunction. Large clinical outcome trials testing traditional anti - atherosclerosis and anti-anginal as well as novel strategies in this population are needed. Existing guidelines for diagnosis and treatment of patients with chest pain and normal coronary arteries need to be updated, based on this existing body of evidence, as well as from results of ongoing and future investigation.