Survey Study to Differentiate Vasospastic Angina From Coronary Microvascular Dysfunction in Real-World Management of Ischemia With NonObstructive Coronary Artery Disease.

The appropriate management of ischemia with nonobstructive coronary artery disease (INOCA) has now become a globally recognized issue. However, there is a lack of studies examining how cardiologists manage INOCA by differentiating between vasospastic angina and coronary microvascular dysfunction (CMD) endotypes in real clinical practice, as well as the extent to which they are satisfied with their current diagnostic and management approaches. This survey collected data through a web-based questionnaire conducted between October 15, 2024, and November 15, 2024, targeting Japanese cardiologists who were members of a cardiology-specific website. In total, 158 cardiologists responded to the survey. Approximately 54% of the cardiologists reported having clinical experience with <10 INOCA patients. Only 15% reported being very satisfied or satisfied with the management of INOCA. Cardiologists prescribing or recommending beta-blockers for CMD endotype patients exhibited significantly higher odds of INOCA management satisfaction (OR, 3.80; 95% CI 1.38 to 11.2; p = 0.0047). Furthermore, specialization in interventional cardiology was associated with increased odds (OR, 5.97; 95% CI 1.67 to 32.7; p = 0.0016), and satisfied cardiologists were significantly more likely to pay more attention to the presence of CMD (p = 0.017) and order physiological assessments (p = 0.026). Although awareness of INOCA is growing, overall satisfaction with its clinical management remains low among cardiologists. Those who are more attentive to CMD and differentiate among INOCA endotypes tend to report higher satisfaction. In conclusion, these findings highlight the need for additional research and better dissemination of diagnostic and treatment strategies to improve quality of care.