Current Medical Therapy in Epicardial and Microvascular Disease: Evidence and Gaps.

Francesco Angeli, Matteo Armillotta, Luca Bergamaschi, Carmine Pizzi

Journal: Cardiology clinics 2026;44(4):623-634

PMID: 42822901

Full Text on W.B. Saunders View on PubMed

Abstract

Management of chronic coronary syndromes has shifted from an obstructive coronary artery disease-focused model to a phenotype-guided approach that includes angina with nonobstructive coronary arteries/ ischemia with nonobstructive coronary arteries (INOCA), vasospastic angina (VSA), and coronary microvascular dysfunction (CMD). Background therapies such as statins, angiotensin-converting enzyme inhibitors, antiplatelets, and sodium-glucose cotransporter-2 inhibitor inhibitors improve vascular health, but the WARRIOR trial highlighted the limits of intensive therapy in unselected INOCA patients. Anti-ischemic treatment should be mechanism-based: calcium channel blockers for VSA, beta-blockers and ranolazine for CMD, while nitrates may worsen microvascular disease.

Address: Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti, Bologna, Italy; Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forlì, Italy.; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti, Bologna, Italy; Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forlì, Italy. Electronic address: [email protected].

DOI: 10.1016/j.ccl.2026.07.002

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MeSH Terms: Humans, Coronary Artery Disease, Cardiovascular Agents, Pericardium