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Implementation of the First Dedicated INOCA and Refractory Angina Clinic in Portugal: Early Experience and Clinical Impact
Session:
Sessão de Posters 34 - INOCA, MINOCA e a zona cinzenta da doença coronária
Speaker:
Inês Ferreira Neves
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.7 Non-Atherosclerotic Coronary Abnormalities
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Inês Ferreira Neves; Miguel Marques Antunes; André Ferreira; Tiago Mendonça; Tiago Pereira da Silva; Duarte Cacela; Rui Cruz Ferreira; Ruben Ramos
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Background: Ischemia with non-obstructive coronary arteries (INOCA) and refractory angina represent a growing clinical challenge, frequently leading to recurrent hospital visits, delayed diagnosis, and suboptimal management. Despite increasing recognition of coronary microvascular dysfunction and vasospastic angina, dedicated care pathways remain limited in Portugal.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Objective: To describe the early outcomes of the first specialized INOCA and refractory angina consultation implemented in our hospital center.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Methods: A multidisciplinary clinic was established in January 2025, integrating interventional cardiologists with expertise in coronary physiology and chronic total occlusions (CTOs), cardiologists with advanced cardiovascular imaging expertise, and individualized pharmacologic management. A standardized assessment pathway was developed, including structured symptom evaluation, stratified non-invasive testing, invasive coronary function assessment when clinically indicated, and personalized therapeutic planning. We conducted a prospective evaluation of the first cohort of patients referred for suspected INOCA or refractory angina.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Results: During the first year, the clinic received 56 referrals, of whom 45 patients are currently being followed (mean age 67 ± 9.4 years; 55.6% male). Vasospastic angina was the most frequent diagnosis, identified in 27 patients (60%), followed by coronary artery disease after PCI and/or CABG without further revascularization targets (44.4%). The mean time from referral to first consultation was 65 ± 36 days. Significant improvements were observed in both angina severity and functional capacity: CCS class decreased by a mean of 0.76 ± 0.83 (p < 0.001), and NYHA class improved by 0.24 ± 0.44 (p = 0.021). No emergency department visits or urgent hospital admissions occurred during follow-up.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Conclusion: The establishment of the first dedicated INOCA and refractory angina clinic in Portugal proved both feasible and clinically impactful. Structured evaluation and personalized management enabled more accurate diagnosis and meaningful symptom improvement in a complex and frequently under-recognized patient population.</span></span></p>
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