Introduction: The Paradox of Clear Arteries
For decades, the clinical management of chest pain has been dominated by a binary focus: the presence or absence of obstructive coronary artery disease (CAD). However, a significant proportion of patients—predominantly women—present with classic anginal symptoms but show no evidence of macrovascular obstruction during angiography. This condition, often termed Ischemia with No Obstructive Coronary Arteries (INOCA), has historically been dismissed as benign. Recent evidence, however, suggests that these patients suffer from microvascular dysfunction or vasospasms and carry a higher risk of adverse cardiovascular events. The WOMANOCA nationwide cohort study provides a critical lens into the long-term healthcare utilization of this population, challenging the notion that a clean angiogram equates to clinical resolution.
