Ишемия миокарда без обструкции коронарных артерий (INOCA). Часть I. Современное представление об INOCA

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.

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