Angina pectoris may arise from obstructive coronary artery disease (CAD) or in the absence of significant CAD (ischemia with nonobstructed coronary arteries [INOCA]). Therapeutic strategies for patients with angina and obstructive CAD focus on reducing cardiovascular events and relieving symptoms, whereas in INOCA the focus shifts toward managing functional alterations of the coronary circulation. In obstructive CAD, coronary revascularization might improve angina status, although a significant percentage of patients present angina persistence or recurrence, suggesting the presence of functional mechanisms along with epicardial CAD. In patients with INOCA, performing a precise endotype diagnosis is crucial to allow a tailored therapy targeted toward the specific pathogenic mechanism. In this expert opinion paper, we review the evidence for the management of angina, highlighting the complementary role of coronary revascularization, optimal medical therapy, and lifestyle interventions and underscoring the importance of a personalized approach that targets the underlying pathobiology.

中文翻译：

---

稳定型心绞痛的优化管理：以患者为中心的方法，整合血运重建、药物治疗和生活方式干预


心绞痛可能由阻塞性冠状动脉疾病 (CAD) 或无明显 CAD（非阻塞性冠状动脉缺血 [INOCA]）引起。心绞痛和阻塞性 CAD 患者的治疗策略侧重于减少心血管事件和缓解症状，而 INOCA 的治疗重点转向管理冠状循环的功能改变。在阻塞性 CAD 中，冠状动脉血运重建可能会改善心绞痛状态，尽管相当大比例的患者出现心绞痛持续或复发，这表明功能机制与心外膜 CAD 一起存在。对于 INOCA 患者，进行精确的内型诊断对于针对特定致病机制进行定制治疗至关重要。在这篇专家意见论文中，我们回顾了心绞痛治疗的证据，强调了冠状动脉血运重建、最佳药物治疗和生活方式干预的互补作用，并强调了针对潜在病理学的个性化方法的重要性。