Table 3.

Currently Available Medical Treatment Options for INOCA

Treatment Agents	Clinical Effects	Applicable Endotypes of INOCA
		Coronary Microvascular Disease	Epicardial Vasospastic Angina	Microvascular Vasospastic Angina
ACE inhibitor/ARB	•Improve endothelial function •Improve small vessel remodeling •Regress periarteriolar fibrosis	+	−	−
Beta-blocker	•Reduce myocardial oxygen demand and increase diastolic perfusion time by reducing heart rate and contractility •Increase the threshold of ischemic symptom •Improve endothelial function	+	−	−
Nitrates	•Dilate vascular smooth muscle •Reduce preload via systemic vasodilation	−	+	±
CCB	•Dilate vascular smooth muscle •Increase the threshold of ischemic symptom •Reduce myocardial oxygen demand •Improve symptom and exercise tolerance	±	+	+
Statin	•Anti-inflammatory and antioxidant properties •Improve coronary endothelial function	+	−	−
Nicorandil	•Coronary microvascular dilatory effect •Balanced vasodilator in veins and arteries	±	+	+
Ranolazine	•Reduce myocardial oxygen demand and improve microvascular perfusion via improvement of ventricular relaxation	+	−	−
Trimetazidine	•Increase cell tolerance to ischemia via cellular homeostasis	+	-	-

ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; CCB = calcium-channel blocker; INOCA = ischemia with nonobstructive coronary arteries.