medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2025-18-12-19medalphabet-4532Research ArticleСтатьиИшемия миокарда без обструкции коронарных артерий (INOCA). Часть I. Современное представление об INOCAMyocardial ischemia with nonobstructive coronary arteries (INOCA). Part I. The current state of INOCA problemhttps://orcid.org/0009-0001-8861-8221МовсисянД. М.MovsisyanD. M.

Мовсисян Давид Маисович, младший научный сотрудник отделения неотложной клинической кардиологии с методами неинвазивной функциональной диагностики

Москва

Movsisyan David M., junior researcher at Dept of Emergency Clinical Cardiology with Non-invasive Functional Diagnostics

Moscow

davidmovsisyan1112@gmail.comhttps://orcid.org/0009-0005-8752-1128КомиссаровЕ. А.KomissarovE. A.

Комиссаров Евгений Александрович, клинический ординатор

Москва

Komissarov Evgeny A., clinical resident

Moscow

jkumys@mail.ruhttps://orcid.org/0000-0002-6229-8629АлиджановаХ. Г.AlidzhanovaKh. G.

Алиджанова Хафиза Гафуровна, д.м.н., старший преподаватель учебного центра, старший научный сотрудник отделения неотложной кардиологии с методами неинвазивной диагностики

Москва

Alidzhanova Khafiza G., DM Sci (habil.), senior lecturer at Training Center, senior researcher at Dept of Emergency Cardiology with Non-invasive Diagnostics

Moscow

alidzhanovahg@sklif.mos.ruГБУЗ г. Москвы «Научно-исследовательский институт скорой помощи имени Н.В. Склифосовского Департамента здравоохранения Москвы»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian Federation202501092025018Кардиология. Неотложная медицина (2)1219Copyright © Мовсисян Д.М., Комиссаров Е.А., Алиджанова Х.Г., 20252025Мовсисян Д.М., Комиссаров Е.А., Алиджанова Х.Г.Movsisyan D.M., Komissarov E.A., Alidzhanova K.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/4532

Ишемическая болезнь сердца (ИБС) без обструктивного поражения коронарных артерий (INOCA, ischemia with nonobstructive coronary arteries) – собирательный термин, объединяющий формы ИБС, при которых отсутствует обструктивное поражение коронарных артерий: вазоспастическая стенокардия (ВС), микрососудистая стенокардия (МС) и мышечный миокардиальный мостик (МММ). По данным коронароангиографии (КАГ), у 37–39% обследованных отсутствуют гемодинамически значимые стенозы коронарных артерий (КА). Клиническое течение заболевания сопровождается значительными ограничениями качества жизни, снижением трудоспособности; выше риск развития сердечно-сосудистых событий (ССС), выживаемость ниже, чем в здоровой популяции. Выделяют 2 основных патогенетических механизма: микроциркуляторная дисфункция и вазоспазм. На основании литературных данных проведена дифференциация двух наиболее часто встречающихся эндотипов INOCA. МММ выделяют в отдельную группу структурного вазоспазма. В диагностике INOCA основная роль отводится определению ведущего патофизиологического механизма путем измерения параметров коронарного кровотока и проведения ацетилхолинового провокационного теста на вазоспазм. Лечение МС сходно с таковым при обструктивной ИБС с возможным добавлением метаболической терапии; при ВС препаратами выбора являются антагонисты кальция.

INOCA (ischemia with nonobstructive coronary arteries) is a general term for different types of coronary artery disease which excludes an obstruction of the coronary arteries: vasospastic angina, microvascular angina and muscular myocardial bridge. According to coronary angiography data, 37–39% of patients don’t have hemodynamically significant stenoses of the coronary arteries. INOCA is assigned with significant quality of life limitations, decreased working capacity, the risk of major cardiovascular events is higher and survival rate is lower than in a healthy population. Two main pathogenetic mechanisms were studied and differentiated based on scientific data: microcirculatory dysfunction and vasospasm. Myocardial bridge is classified as structural vasospasm endotype. Coronary blood flow examination and an acetylcholine provocation test are the main diagnostical procedures, which can help to determine the leading pathophysiological mechanism of INOCA. Microvascular disease treatment is pretty similar to an obstructive coronary disease therapy with the possible addition of metabolic therapy. In vasospastic angina front-line drugs are calcium antagonists.

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The authors declare that there are no conflicts of interest present.