{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:59:03Z","timestamp":1790697543669,"version":"4.1.0"},"reference-count":119,"publisher":"IMR Press","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Vasospastic angina and microvascular angina are increasingly recognized as important causes of myocardial ischemia in patients with angina or myocardial infarction and non-obstructive coronary arteries (ANOCA\/MINOCA). Unlike obstructive coronary artery disease, these conditions result from dynamic alterations in epicardial and\/or microvascular tone that are not detected by standard coronary angiography. Intracoronary acetylcholine (ACh) provocation testing enables direct assessment of coronary vasomotor function by evaluating both endothelial integrity and smooth muscle reactivity. Moreover, ACh can identify epicardial spasm, microvascular spasm, or impaired endothelium-dependent vasodilation, thereby providing precise characterization of the underlying pathophysiological mechanism. When performed using standardized protocols, ACh testing has shown a high diagnostic yield and a reassuring safety profile. In addition to the associated diagnostic relevance, the ACh response carries prognostic significance, as abnormal findings are associated with a higher risk of recurrent angina and adverse cardiovascular events. Furthermore, randomized data demonstrated that treatment tailored to invasive coronary function testing improves symptoms and quality of life. This review summarizes the pathophysiological background, practical aspects, safety, and clinical value of ACh provocation testing, underscoring its central role in a more personalized approach to patients with ANOCA\/MINOCA.<\/jats:p>","DOI":"10.31083\/rcm52151","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:57:11Z","timestamp":1790693831000},"source":"Crossref","is-referenced-by-count":0,"title":["Acetylcholine Provocation Testing for Coronary Vasomotor Disorders"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5264-1043","authenticated-orcid":true,"given":"Andrea","family":"Caff\u00e8","sequence":"first","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5441-9276","authenticated-orcid":true,"given":"Francesco M.","family":"Animati","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6439-1018","authenticated-orcid":true,"given":"Rocco A.","family":"Montone","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"},{"name":"Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AHEM, et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2021; 16: 1049\u20131069.","DOI":"10.4244\/EIJY20M07_01"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Samuels BA, Shah SM, Widmer RJ, Kobayashi Y, Miner SES, Taqueti VR, et al. Comprehensive Management of ANOCA, Part 1-Definition, Patient Population, and Diagnosis: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2023; 82: 1245\u20131263.","DOI":"10.1016\/j.jacc.2023.06.043"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Montone RA, Rinaldi R, Niccoli G, And\u00f2 G, Gragnano F, Piccolo R, et al. Optimizing Management of Stable Angina: A Patient-Centered Approach Integrating Revascularization, Medical Therapy, and Lifestyle Interventions. Journal of the American College of Cardiology. 2024; 84: 744\u2013760.","DOI":"10.1016\/j.jacc.2024.06.015"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM, et al. Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association. Circulation. 2019; 139: e891\u2013e908.","DOI":"10.1161\/CIR.0000000000000670"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Ong P, Athanasiadis A, Borgulya G, Mahrholdt H, Kaski JC, Sechtem U. High prevalence of a pathological response to acetylcholine testing in patients with stable angina pectoris and unobstructed coronary arteries. The ACOVA Study (Abnormal COronary VAsomotion in patients with stable angina and unobstructed coronary arteries). Journal of the American College of Cardiology. 2012; 59: 655\u2013662.","DOI":"10.1016\/j.jacc.2011.11.015"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Ong P, Athanasiadis A, Hill S, Vogelsberg H, Voehringer M, Sechtem U. Coronary artery spasm as a frequent cause of acute coronary syndrome: The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study. Journal of the American College of Cardiology. 2008; 52: 523\u2013527.","DOI":"10.1016\/j.jacc.2008.04.050"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Montone RA, Niccoli G, Fracassi F, Russo M, Gurgoglione F, Camm\u00e0 G, et al. Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests. European Heart Journal. 2018; 39: 91\u201398.","DOI":"10.1093\/eurheartj\/ehx667"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Ford TJ, Yii E, Sidik N, Good R, Rocchiccioli P, McEntegart M, et al. Ischemia and No Obstructive Coronary Artery Disease: Prevalence and Correlates of Coronary Vasomotion Disorders. Circulation. Cardiovascular Interventions. 2019; 12: e008126.","DOI":"10.1161\/CIRCINTERVENTIONS.119.008126"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Mileva N, Nagumo S, Mizukami T, Sonck J, Berry C, Gallinoro E, et al. Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta-Analysis. Journal of the American Heart Association. 2022; 11: e023207.","DOI":"10.1161\/JAHA.121.023207"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Takagi Y, Takahashi J, Yasuda S, Miyata S, Tsunoda R, Ogata Y, et al. Prognostic stratification of patients with vasospastic angina: a comprehensive clinical risk score developed by the Japanese Coronary Spasm Association. Journal of the American College of Cardiology. 2013; 62: 1144\u20131153.","DOI":"10.1016\/j.jacc.2013.07.018"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Ong P, Athanasiadis A, Borgulya G, Voehringer M, Sechtem U. 3-year follow-up of patients with coronary artery spasm as cause of acute coronary syndrome: the CASPAR (coronary artery spasm in patients with acute coronary syndrome) study follow-up. Journal of the American College of Cardiology. 2011; 57: 147\u2013152.","DOI":"10.1016\/j.jacc.2010.08.626"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Rodr\u00edguez-Ma\u00f1ero M, Oloriz T, le Polain de Waroux JB, Burri H, Kreidieh B, de Asmundis C, et al. Long-term prognosis of patients with life-threatening ventricular arrhythmias induced by coronary artery spasm. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2018; 20: 851\u2013858.","DOI":"10.1093\/europace\/eux052"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. European Heart Journal. 2024; 45: 3415\u20133537.","DOI":"10.1093\/eurheartj\/ehae177"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Montone RA, Caff\u00e8 A, Yasumura K, Kini A. Routine diagnosis of ANOCA\/INOCA: pros and cons. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2025; 21: e293\u2013e295.","DOI":"10.4244\/EIJ-E-24-00072"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. The New England Journal of Medicine. 2010; 362: 886\u2013895.","DOI":"10.1056\/NEJMoa0907272"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Hwang D, Park SH, Koo BK. Ischemia With Nonobstructive Coronary Artery Disease: Concept, Assessment, and Management. JACC. Asia. 2023; 3: 169\u2013184.","DOI":"10.1016\/j.jacasi.2023.01.004"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Montone RA, Meucci MC, De Vita A, Lanza GA, Niccoli G. Coronary provocative tests in the catheterization laboratory: Pathophysiological bases, methodological considerations and clinical implications. Atherosclerosis. 2021; 318: 14\u201321.","DOI":"10.1016\/j.atherosclerosis.2020.12.008"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Leone AM, Galante D, Vicer\u00e9 A, Marrone A, Verardi FM, Giuliana C, et al. Functional coronary assessment in angina with intermediate coronary stenosis: the #FullPhysiology approach. European Heart Journal. 2025; 46: 978\u2013980.","DOI":"10.1093\/eurheartj\/ehae926"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Jer\u00f3nimo A, Paredes-V\u00e1zquez JG, Travieso A, Shabbir A, Jim\u00e9nez-Quevedo P, Macaya-Ten F, et al. Comprehensive diagnosis in chronic coronary syndromes combining angiography and intracoronary testing: the AID-ANGIO study. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2025; 21: 35\u201345.","DOI":"10.4244\/EIJ-D-24-00499"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Ford TJ, Stanley B, Good R, Rocchiccioli P, McEntegart M, Watkins S, et al. Stratified Medical Therapy Using Invasive Coronary Function Testing in Angina: The CorMicA Trial. Journal of the American College of Cardiology. 2018; 72: 2841\u20132855.","DOI":"10.1016\/j.jacc.2018.09.006"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Boerhout CKM, Namba HF, Liu T, Beijk MAM, Damman P, Meuwissen M, et al. Coronary function testing vs angiography alone to guide treatment of angina with non-obstructive coronary arteries: the ILIAS ANOCA trial. European Heart Journal. 2025; 46: 4396\u20134406.","DOI":"10.1093\/eurheartj\/ehaf580"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Montone RA, Rinaldi R, Del Buono MG, Gurgoglione F, La Vecchia G, Russo M, et al. Safety and prognostic relevance of acetylcholine testing in patients with stable myocardial ischaemia or myocardial infarction and non-obstructive coronary arteries. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2022; 18: e666\u2013e676.","DOI":"10.4244\/EIJ-D-21-00971"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Rinaldi R, Russo M, Torre I, Colucci M, Caff\u00e8 A, Scarica V, et al. Prognostic significance of individual COVADIS criteria in patients undergoing acetylcholine provocation testing. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2025; 21: e296\u2013e306.","DOI":"10.4244\/EIJ-D-24-00832"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Okumura K, Yasue H, Matsuyama K, Goto K, Miyagi H, Ogawa H, et al. Sensitivity and specificity of intracoronary injection of acetylcholine for the induction of coronary artery spasm. Journal of the American College of Cardiology. 1988; 12: 883\u2013888.","DOI":"10.1016\/0735-1097(88)90449-4"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Padro T, Manfrini O, Bugiardini R, Canty J, Cenko E, De Luca G, et al. ESC Working Group on Coronary Pathophysiology and Microcirculation position paper on 'coronary microvascular dysfunction in cardiovascular disease'. Cardiovascular Research. 2020; 116: 741\u2013755.","DOI":"10.1093\/cvr\/cvaa003"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Miura H, Bosnjak JJ, Ning G, Saito T, Miura M, Gutterman DD. Role for hydrogen peroxide in flow-induced dilation of human coronary arterioles. Circulation Research. 2003; 92: e31\u201340.","DOI":"10.1161\/01.res.0000054200.44505.ab"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Lanza GA, Careri G, Crea F. Mechanisms of coronary artery spasm. Circulation. 2011; 124: 1774\u20131782.","DOI":"10.1161\/CIRCULATIONAHA.111.037283"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Nishimiya K, Takahashi J, Oyama K, Matsumoto Y, Yasuda S, Shimokawa H. Mechanisms of Coronary Artery Spasm. European Cardiology. 2023; 18: e39.","DOI":"10.15420\/ecr.2022.55"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Shimokawa H, Seto M, Katsumata N, Amano M, Kozai T, Yamawaki T, et al. Rho-kinase-mediated pathway induces enhanced myosin light chain phosphorylations in a swine model of coronary artery spasm. Cardiovascular Research. 1999; 43: 1029\u20131039.","DOI":"10.1016\/s0008-6363(99)00144-3"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Yasue H, Horio Y, Nakamura N, Fujii H, Imoto N, Sonoda R, et al. Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm. Circulation. 1986; 74: 955\u2013963.","DOI":"10.1161\/01.cir.74.5.955"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Beltrame JF, Psaltis PJ. The Forgotten Vascular Layer in the Forgotten Coronary Disorder. Journal of the American College of Cardiology. 2018; 71: 426\u2013428.","DOI":"10.1016\/j.jacc.2017.10.095"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Ga\u0161p\u00e1rkov\u00e1 V, Tran BT, O\u0161\u0165\u00e1dal P, Lambert L, H\u00e1jek P, Kala P. Epicardial adipose tissue in coronary microvascular disease. American Heart Journal Plus : Cardiology Research and Practice. 2026; 63: 100734.","DOI":"10.1016\/j.ahjo.2026.100734"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Shimokawa H, Ito A, Fukumoto Y, Kadokami T, Nakaike R, Sakata M, et al. Chronic treatment with interleukin-1 beta induces coronary intimal lesions and vasospastic responses in pigs in vivo. The role of platelet-derived growth factor. The Journal of Clinical Investigation. 1996; 97: 769\u2013776.","DOI":"10.1172\/JCI118476"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Takaoka K, Yoshimura M, Ogawa H, Kugiyama K, Nakayama M, Shimasaki Y, et al. Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking. International Journal of Cardiology. 2000; 72: 121\u2013126.","DOI":"10.1016\/s0167-5273(99)00172-2"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Beltrame JF, Sasayama S, Maseri A. Racial heterogeneity in coronary artery vasomotor reactivity: differences between Japanese and Caucasian patients. Journal of the American College of Cardiology. 1999; 33: 1442\u20131452.","DOI":"10.1016\/s0735-1097(99)00073-x"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Kaneda H, Taguchi J, Kuwada Y, Hangaishi M, Aizawa T, Yamakado M, et al. Coronary artery spasm and the polymorphisms of the endothelial nitric oxide synthase gene. Circulation Journal : Official Journal of the Japanese Circulation Society. 2006; 70: 409\u2013413.","DOI":"10.1253\/circj.70.409"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Hikino K, Koyama S, Ito K, Koike Y, Koido M, Matsumura T, et al. RNF213 Variants, Vasospastic Angina, and Risk of Fatal Myocardial Infarction. JAMA Cardiology. 2024; 9: 723\u2013731.","DOI":"10.1001\/jamacardio.2024.1483"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Manzato M, Kalhor P, Nogami K, Pinna A, Montone RA, Lerman LO, et al. Chronic PM2.5 Exposure Is Associated With Invasively Assessed Coronary Endothelial Dysfunction. Journal of the American College of Cardiology. 2026; S0735\u2013S0735\u20131097(26)06134\u20136.","DOI":"10.1016\/j.jacc.2026.03.155"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Corban MT, Hung OY, Eshtehardi P, Rasoul-Arzrumly E, McDaniel M, Mekonnen G, et al. Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies. Journal of the American College of Cardiology. 2014; 63: 2346\u20132355.","DOI":"10.1016\/j.jacc.2014.01.049"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Herrmann J, Higano ST, Lenon RJ, Rihal CS, Lerman A. Myocardial bridging is associated with alteration in coronary vasoreactivity. European Heart Journal. 2004; 25: 2134\u20132142.","DOI":"10.1016\/j.ehj.2004.08.015"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Saito Y, Kitahara H, Shoji T, Tokimasa S, Nakayama T, Sugimoto K, et al. Relation between severity of myocardial bridge and vasospasm. International Journal of Cardiology. 2017; 248: 34\u201338.","DOI":"10.1016\/j.ijcard.2017.07.002"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Nam P, Choi BG, Choi SY, Byun JK, Mashaly A, Park Y, et al. The impact of myocardial bridge on coronary artery spasm and long-term clinical outcomes in patients without significant atherosclerotic stenosis. Atherosclerosis. 2018; 270: 8\u201312.","DOI":"10.1016\/j.atherosclerosis.2018.01.026"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Montone RA, Gurgoglione FL, Del Buono MG, Rinaldi R, Meucci MC, Iannaccone G, et al. Interplay Between Myocardial Bridging and Coronary Spasm in Patients With Myocardial Ischemia and Non-Obstructive Coronary Arteries: Pathogenic and Prognostic Implications. Journal of the American Heart Association. 2021; 10: e020535.","DOI":"10.1161\/JAHA.120.020535"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Sara JDS, Corban MT, Prasad M, Prasad A, Gulati R, Lerman LO, et al. Prevalence of myocardial bridging associated with coronary endothelial dysfunction in patients with chest pain and non-obstructive coronary artery disease. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2020; 15: 1262\u20131268.","DOI":"10.4244\/EIJ-D-18-00920"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Camici PG, Crea F. Coronary microvascular dysfunction. The New England Journal of Medicine. 2007; 356: 830\u2013840.","DOI":"10.1056\/NEJMra061889"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Smilowitz NR, Toleva O, Chieffo A, Perera D, Berry C. Coronary Microvascular Disease in Contemporary Clinical Practice. Circulation. Cardiovascular Interventions. 2023; 16: e012568.","DOI":"10.1161\/CIRCINTERVENTIONS.122.012568"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Egashira K, Inou T, Hirooka Y, Yamada A, Urabe Y, Takeshita A. Evidence of impaired endothelium-dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. The New England Journal of Medicine. 1993; 328: 1659\u20131664.","DOI":"10.1056\/NEJM199306103282302"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Lee BK, Lim HS, Fearon WF, Yong AS, Yamada R, Tanaka S, et al. Invasive evaluation of patients with angina in the absence of obstructive coronary artery disease. Circulation. 2015; 131: 1054\u20131060.","DOI":"10.1161\/CIRCULATIONAHA.114.012636"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Scarsini R, Campo G, DI Serafino L, Zanon S, Rubino F, Monizzi G, et al. #FullPhysiology: a systematic step-by-step guide to implement intracoronary physiology in daily practice. Minerva Cardiology and Angiology. 2023; 71: 504\u2013514.","DOI":"10.23736\/S2724-5683.23.06414-1"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Hada M, Kakuta T, Ueno H, Kanaji Y, Usui E, Nagamine T, et al. Comprehensive Endotyping of Patients With Angina and Nonobstructive Coronary Arteries: A Report From the J-CMD. Journal of the American Heart Association. 2026; 15: e048016.","DOI":"10.1161\/JAHA.125.048016"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"Miner S, Mejia-Renteria H, Leone AM, Velollari O, Sykes R, Biscaglia S, et al. Endotypes of angina with non-obstructive coronary arteries: a prospective multicentre study. European Heart Journal. 2026; 47: 594\u2013604.","DOI":"10.1093\/eurheartj\/ehaf839"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"Aziz A, Hansen HS, Sechtem U, Prescott E, Ong P. Sex-Related Differences in Vasomotor Function in Patients With Angina and Unobstructed Coronary Arteries. Journal of the American College of Cardiology. 2017; 70: 2349\u20132358.","DOI":"10.1016\/j.jacc.2017.09.016"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"Murthy VL, Naya M, Taqueti VR, Foster CR, Gaber M, Hainer J, et al. Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation. 2014; 129: 2518\u20132527.","DOI":"10.1161\/CIRCULATIONAHA.113.008507"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"Ong P, Hubert A, Schwidder M, Beltrame JF. Coronary Spasm: Ethnic and Sex Differences. European Cardiology. 2023; 18: e43.","DOI":"10.15420\/ecr.2023.13"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"Sato K, Kaikita K, Nakayama N, Horio E, Yoshimura H, Ono T, et al. Coronary vasomotor response to intracoronary acetylcholine injection, clinical features, and long-term prognosis in 873 consecutive patients with coronary spasm: analysis of a single-center study over 20 years. Journal of the American Heart Association. 2013; 2: e000227.","DOI":"10.1161\/JAHA.113.000227"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Bairey Merz CN, Pepine CJ, Walsh MN, Fleg JL. Ischemia and No Obstructive Coronary Artery Disease (INOCA): Developing Evidence-Based Therapies and Research Agenda for the Next Decade. Circulation. 2017; 135: 1075\u20131092.","DOI":"10.1161\/CIRCULATIONAHA.116.024534"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"Bossaller C, Habib GB, Yamamoto H, Williams C, Wells S, Henry PD. Impaired muscarinic endothelium-dependent relaxation and cyclic guanosine 5'-monophosphate formation in atherosclerotic human coronary artery and rabbit aorta. The Journal of Clinical Investigation. 1987; 79: 170\u2013174.","DOI":"10.1172\/JCI112779"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980; 288: 373\u2013376.","DOI":"10.1038\/288373a0"},{"key":"ref59","doi-asserted-by":"publisher","unstructured":"Okumura K, Yasue H, Horio Y, Takaoka K, Matsuyama K, Kugiyama K, et al. Multivessel coronary spasm in patients with variant angina: a study with intracoronary injection of acetylcholine. Circulation. 1988; 77: 535\u2013542.","DOI":"10.1161\/01.cir.77.3.535"},{"key":"ref60","doi-asserted-by":"publisher","unstructured":"Sueda S, Kohno H, Fukuda H, Ochi N, Kawada H, Hayashi Y, et al. Induction of coronary artery spasm by two pharmacological agents: comparison between intracoronary injection of acetylcholine and ergonovine. Coronary Artery Disease. 2003; 14: 451\u2013457.","DOI":"10.1097\/00019501-200309000-00006"},{"key":"ref61","doi-asserted-by":"publisher","unstructured":"Ong P, Athanasiadis A, Borgulya G, Vokshi I, Bastiaenen R, Kubik S, et al. Clinical usefulness, angiographic characteristics, and safety evaluation of intracoronary acetylcholine provocation testing among 921 consecutive white patients with unobstructed coronary arteries. Circulation. 2014; 129: 1723\u20131730.","DOI":"10.1161\/CIRCULATIONAHA.113.004096"},{"key":"ref62","doi-asserted-by":"publisher","unstructured":"Sueda S, Kohno H, Fukuda H, Ochi N, Kawada H, Hayashi Y, et al. Frequency of provoked coronary spasms in patients undergoing coronary arteriography using a spasm provocation test via intracoronary administration of ergonovine. Angiology. 2004; 55: 403\u2013411.","DOI":"10.1177\/000331970405500407"},{"key":"ref63","doi-asserted-by":"publisher","unstructured":"Sueda S, Miyoshi T, Sasaki Y, Sakaue T, Habara H, Kohno H. Gender differences in sensitivity of acetylcholine and ergonovine to coronary spasm provocation test. Heart and Vessels. 2016; 31: 322\u2013329.","DOI":"10.1007\/s00380-014-0614-4"},{"key":"ref64","doi-asserted-by":"publisher","unstructured":"Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, et al. International standardization of diagnostic criteria for vasospastic angina. European Heart Journal. 2017; 38: 2565\u20132568.","DOI":"10.1093\/eurheartj\/ehv351"},{"key":"ref65","doi-asserted-by":"publisher","unstructured":"Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal. 2023; 44: 3720\u20133826.","DOI":"10.1093\/eurheartj\/ehad191"},{"key":"ref66","doi-asserted-by":"publisher","unstructured":"Hokimoto S, Kaikita K, Yasuda S, Tsujita K, Ishihara M, Matoba T, et al. JCS\/CVIT\/JCC 2023 Guideline Focused Update on Diagnosis and Treatment of Vasospastic Angina (Coronary Spastic Angina) and Coronary Microvascular Dysfunction. Circulation Journal : Official Journal of the Japanese Circulation Society. 2023; 87: 879\u2013936.","DOI":"10.1253\/circj.CJ-22-0779"},{"key":"ref67","doi-asserted-by":"publisher","unstructured":"Rinaldi R, Colucci M, Torre I, Ausiello D, Bonanni A, Basile M, et al. Predicting the response to acetylcholine in ischemia or infarction with non-obstructive coronary arteries: The ABCD score. Atherosclerosis. 2024; 391: 117503.","DOI":"10.1016\/j.atherosclerosis.2024.117503"},{"key":"ref68","doi-asserted-by":"publisher","unstructured":"Tateishi K, Saito Y, Kitahara H, Shoji T, Kadohira T, Nakayama T, et al. Safety and usefulness of acetylcholine provocation test in patients with no culprit lesions on emergency coronary angiography. International Journal of Cardiology. 2018; 269: 27\u201330.","DOI":"10.1016\/j.ijcard.2018.06.108"},{"key":"ref69","doi-asserted-by":"publisher","unstructured":"Probst S, Seitz A, Mart\u00ednez Pereyra V, Hubert A, Becker A, Storm K, et al. Safety assessment and results of coronary spasm provocation testing in patients with myocardial infarction with unobstructed coronary arteries compared to patients with stable angina and unobstructed coronary arteries. European Heart Journal. Acute Cardiovascular Care. 2021; 10: 380\u2013387.","DOI":"10.1177\/2048872620932422"},{"key":"ref70","doi-asserted-by":"publisher","unstructured":"Perera D, Berry C, Hoole SP, Sinha A, Rahman H, Morris PD, et al. Invasive coronary physiology in patients with angina and non-obstructive coronary artery disease: a consensus document from the coronary microvascular dysfunction workstream of the British Heart Foundation\/National Institute for Health Research Partnership. Heart (British Cardiac Society). 2022; 109: 88\u201395.","DOI":"10.1136\/heartjnl-2021-320718"},{"key":"ref71","doi-asserted-by":"publisher","unstructured":"Feenstra RGT, Seitz A, Boerhout CKM, Bukkems LH, Stegehuis VE, Teeuwisse PJI, et al. Principles and pitfalls in coronary vasomotor function testing. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2022; 17: 1271\u20131280.","DOI":"10.4244\/EIJ-D-21-00402"},{"key":"ref72","doi-asserted-by":"publisher","unstructured":"Sueda S, Kohno H, Ochi T, Uraoka T, Tsunemitsu K. Overview of the pharmacological spasm provocation test: Comparisons between acetylcholine and ergonovine. Journal of Cardiology. 2017; 69: 57\u201365.","DOI":"10.1016\/j.jjcc.2016.09.012"},{"key":"ref73","doi-asserted-by":"publisher","unstructured":"Woudstra J, Feenstra RGT, Vink CEM, Marques KMJ, Boerhout CKM, de Jong EAM, et al. Comparison of the Diagnostic Yield of Intracoronary Acetylcholine Infusion and Acetylcholine Bolus Injection Protocols During Invasive Coronary Function Testing. The American Journal of Cardiology. 2024; 217: 49\u201358.","DOI":"10.1016\/j.amjcard.2024.01.038"},{"key":"ref74","doi-asserted-by":"publisher","unstructured":"JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013). Circulation Journal : Official Journal of the Japanese Circulation Society. 2014; 78: 2779\u20132801.","DOI":"10.1253\/circj.cj-66-0098"},{"key":"ref75","doi-asserted-by":"publisher","unstructured":"Ong P, Camici PG, Beltrame JF, Crea F, Shimokawa H, Sechtem U, et al. International standardization of diagnostic criteria for microvascular angina. International Journal of Cardiology. 2018; 250: 16\u201320.","DOI":"10.1016\/j.ijcard.2017.08.068"},{"key":"ref76","doi-asserted-by":"publisher","unstructured":"Takagi Y, Yasuda S, Takahashi J, Tsunoda R, Ogata Y, Seki A, et al. Clinical implications of provocation tests for coronary artery spasm: safety, arrhythmic complications, and prognostic impact: multicentre registry study of the Japanese Coronary Spasm Association. European Heart Journal. 2013; 34: 258\u2013267.","DOI":"10.1093\/eurheartj\/ehs199"},{"key":"ref77","doi-asserted-by":"publisher","unstructured":"Kanaji Y, Ahmad A, Sara JDS, Ozcan I, Akhiyat N, Prasad A, et al. Coronary Vasomotor Dysfunction Is Associated With Cardiovascular Events in Patients With Nonobstructive Coronary Artery Disease. JACC. Cardiovascular Interventions. 2024; 17: 474\u2013487.","DOI":"10.1016\/j.jcin.2023.11.039"},{"key":"ref78","doi-asserted-by":"publisher","unstructured":"Godo S, Takahashi J, Shiroto T, Yasuda S, Shimokawa H. Coronary Microvascular Spasm: Clinical Presentation and Diagnosis. European Cardiology. 2023; 18: e07.","DOI":"10.15420\/ecr.2022.50"},{"key":"ref79","doi-asserted-by":"publisher","unstructured":"Sun H, Fukumoto Y, Ito A, Shimokawa H, Sunagawa K. Coronary microvascular dysfunction in patients with microvascular angina: analysis by TIMI frame count. Journal of Cardiovascular Pharmacology. 2005; 46: 622\u2013626.","DOI":"10.1097\/01.fjc.0000181291.96086.ae"},{"key":"ref80","doi-asserted-by":"publisher","unstructured":"Teragawa H, Oshita C, Uchimura Y. Do changes in intracoronary pressure aid coronary spasm diagnosis using the spasm provocation test? World Journal of Cardiology. 2024; 16: 16\u201326.","DOI":"10.4330\/wjc.v16.i1.16"},{"key":"ref81","doi-asserted-by":"publisher","unstructured":"Seitz A, Mart\u00ednez Pereyra V, Froebel S, Hubert A, McChord J, Bekeredjian R, et al. Characterization and implications of intracoronary hemodynamic assessment during coronary spasm provocation testing. Clinical Research in Cardiology : Official Journal of the German Cardiac Society. 2023; 112: 1312\u20131321.","DOI":"10.1007\/s00392-023-02224-1"},{"key":"ref82","doi-asserted-by":"publisher","unstructured":"Seitz A, Feenstra R, Konst RE, Mart\u00ednez Pereyra V, Beck S, Beijk M, et al. Acetylcholine Rechallenge: A First Step Toward Tailored Treatment in Patients With Coronary Artery Spasm. JACC. Cardiovascular Interventions. 2022; 15: 65\u201375.","DOI":"10.1016\/j.jcin.2021.10.003"},{"key":"ref83","doi-asserted-by":"publisher","unstructured":"Feenstra RGT, van de Hoef TP, Beijk MAM, Piek JJ. Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration. Journal of Visualized Experiments : JoVE. 2022;  https:\/\/doi.org\/10.3791\/62406","DOI":"10.3791\/62406"},{"key":"ref84","doi-asserted-by":"publisher","unstructured":"Wei J, Mehta PK, Johnson BD, Samuels B, Kar S, Anderson RD, et al. Safety of coronary reactivity testing in women with no obstructive coronary artery disease: results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study. JACC. Cardiovascular Interventions. 2012; 5: 646\u2013653.","DOI":"10.1016\/j.jcin.2012.01.023"},{"key":"ref85","doi-asserted-by":"publisher","unstructured":"Hasdai D, Gibbons RJ, Holmes DR Jr, Higano ST, Lerman A. Coronary endothelial dysfunction in humans is associated with myocardial perfusion defects. Circulation. 1997; 96: 3390\u20133395.","DOI":"10.1161\/01.cir.96.10.3390"},{"key":"ref86","doi-asserted-by":"publisher","unstructured":"Rahman H, Demir OM, Ryan M, McConkey H, Scannell C, Ellis H, et al. Optimal Use of Vasodilators for Diagnosis of Microvascular Angina in the Cardiac Catheterization Laboratory. Circulation. Cardiovascular Interventions. 2020; 13: e009019.","DOI":"10.1161\/CIRCINTERVENTIONS.120.009019"},{"key":"ref87","doi-asserted-by":"publisher","unstructured":"Sara JD, Widmer RJ, Matsuzawa Y, Lennon RJ, Lerman LO, Lerman A. Prevalence of Coronary Microvascular Dysfunction Among Patients With Chest Pain and Nonobstructive Coronary Artery Disease. JACC. Cardiovascular Interventions. 2015; 8: 1445\u20131453.","DOI":"10.1016\/j.jcin.2015.06.017"},{"key":"ref88","doi-asserted-by":"publisher","unstructured":"Miner SES, McCarthy MC, Ardern CI, Perry CGR, Toleva O, Nield LE, et al. The relationships between acetylcholine-induced chest pain, objective measures of coronary vascular function and symptom status. Frontiers in Cardiovascular Medicine. 2023; 10: 1217731.","DOI":"10.3389\/fcvm.2023.1217731"},{"key":"ref89","doi-asserted-by":"publisher","unstructured":"Okumura K, Yasue H, Matsuyama K, Ogawa H, Kugiyama K, Sakaino N, et al. A study on coronary hemodynamics during acetylcholine-induced coronary spasm in patients with variant angina: endothelium-dependent dilation in the resistance vessels. Journal of the American College of Cardiology. 1992; 19: 1426\u20131434.","DOI":"10.1016\/0735-1097(92)90598-h"},{"key":"ref90","doi-asserted-by":"publisher","unstructured":"Egashira K, Inou T, Yamada A, Hirooka Y, Takeshita A. Preserved endothelium-dependent vasodilation at the vasospastic site in patients with variant angina. The Journal of Clinical Investigation. 1992; 89: 1047\u20131052.","DOI":"10.1172\/JCI115646"},{"key":"ref91","doi-asserted-by":"publisher","unstructured":"Takahashi T, Samuels BA, Li W, Parikh MA, Wei J, Moses JW, et al. Safety of Provocative Testing With Intracoronary Acetylcholine and Implications for Standard Protocols. Journal of the American College of Cardiology. 2022; 79: 2367\u20132378.","DOI":"10.1016\/j.jacc.2022.03.385"},{"key":"ref92","doi-asserted-by":"publisher","unstructured":"Sueda S, Hayashi Y, Ono H, Sakaue T, Ikeda S. Safety and Usefulness of Intracoronary Acetylcholine 200 \u03bcg Into the Left Coronary Artery as Vasoreactivity Testing: Comparisons With Intracoronary Acetylcholine Maximum 100 \u03bcg. Clinical Cardiology. 2024; 47: e70001.","DOI":"10.1002\/clc.70001"},{"key":"ref93","doi-asserted-by":"publisher","unstructured":"Litovsky SH, Antzelevitch C. Differences in the electrophysiological response of canine ventricular subendocardium and subepicardium to acetylcholine and isoproterenol. A direct effect of acetylcholine in ventricular myocardium. Circulation Research. 1990; 67: 615\u2013627.","DOI":"10.1161\/01.res.67.3.615"},{"key":"ref94","doi-asserted-by":"publisher","unstructured":"Ahn WJ, Rha SW, Choi BG, Choi SY, Byun JK, Lee Y, et al. Long-term clinical outcomes according to first responsive dose of acetylcholine in patients with coronary artery spasm. Atherosclerosis. 2025; 409: 120473.","DOI":"10.1016\/j.atherosclerosis.2025.120473"},{"key":"ref95","doi-asserted-by":"publisher","unstructured":"Hoshino M, Yonetsu T, Mizukami A, Matsuda Y, Yoshioka K, Sudo Y, et al. Moderate vasomotor response to acetylcholine provocation test as an indicator of long-term prognosis. Heart and Vessels. 2016; 31: 1943\u20131949.","DOI":"10.1007\/s00380-016-0827-9"},{"key":"ref96","doi-asserted-by":"publisher","unstructured":"Montone RA, Cosentino N, Gorla R, Biscaglia S, La Vecchia G, Rinaldi R, et al. Stratified treatment of myocardial infarction with non-obstructive coronary arteries: the PROMISE trial. European Heart Journal. 2026; 47: 1456\u20131466.","DOI":"10.1093\/eurheartj\/ehaf917"},{"key":"ref97","doi-asserted-by":"publisher","unstructured":"Montone RA, Cosentino N, Graziani F, Gorla R, Del Buono MG, La Vecchia G, et al. Precision medicine versus standard of care for patients with myocardial infarction with non-obstructive coronary arteries (MINOCA): rationale and design of the multicentre, randomised PROMISE trial. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2022; 18: e933\u2013e939.","DOI":"10.4244\/EIJ-D-22-00178"},{"key":"ref98","doi-asserted-by":"publisher","unstructured":"Caff\u00e8 A, Animati FM, Iannaccone G, Rinaldi R, Montone RA. Precision Medicine in Acute Coronary Syndromes. Journal of Clinical Medicine. 2024; 13: 4569.","DOI":"10.3390\/jcm13154569"},{"key":"ref99","doi-asserted-by":"publisher","unstructured":"D'Amario D, Ciliberti G, Restivo A, Laborante R, Migliaro S, Canonico F, et al. Myocardial bridge evaluation towards personalized medicine: study design and preliminary results of the RIALTO registry. European Heart Journal Supplements : Journal of the European Society of Cardiology. 2022; 24: H48\u2013H56.","DOI":"10.1093\/eurheartjsupp\/suac059"},{"key":"ref100","doi-asserted-by":"publisher","unstructured":"Yamazaki T, Saito Y, Yamashita D, Kitahara H, Kobayashi Y. Impact of preceding acetylcholine provocation testing on following coronary physiological assessment during an interventional diagnostic procedure. Journal of Cardiology. 2023; 82: 215\u2013219.","DOI":"10.1016\/j.jjcc.2023.06.010"},{"key":"ref101","doi-asserted-by":"publisher","unstructured":"Sueda S, Kohno H, Miyoshi T, Sakaue T, Sasaki Y, Habara H. Maximal acetylcholine dose of 200 \u03bcg into the left coronary artery as a spasm provocation test: comparison with 100 \u03bcg of acetylcholine. Heart and Vessels. 2015; 30: 771\u2013778.","DOI":"10.1007\/s00380-014-0563-y"},{"key":"ref102","doi-asserted-by":"publisher","unstructured":"Rehan R, Khandur C, Wong CCY, Weaver J, Jain P, Adams M, et al. Diagnostic Validity of Acetylcholine Provocation Protocols in the Evaluation of Coronary Artery Spasm in Patients With ANOCA. Circulation. Cardiovascular Interventions. 2025; 18: e015339.","DOI":"10.1161\/CIRCINTERVENTIONS.125.015339"},{"key":"ref103","doi-asserted-by":"publisher","unstructured":"Sueda S, Kohno H. The acetylcholine administration time plays the key role for provoked spasm in the spasm provocation test. Journal of Cardiology. 2017; 70: 141\u2013146.","DOI":"10.1016\/j.jjcc.2016.11.003"},{"key":"ref104","doi-asserted-by":"publisher","unstructured":"Okuya Y, Saito Y, Kitahara H, Kobayashi Y. Omitting 50 \u03bcg of intracoronary acetylcholine injection in the left coronary artery during spasm provocation test. Journal of Cardiology. 2024; 83: 25\u201329.","DOI":"10.1016\/j.jjcc.2023.07.016"},{"key":"ref105","doi-asserted-by":"publisher","unstructured":"Saito Y, Kitahara H, Shoji T, Tokimasa S, Nakayama T, Sugimoto K, et al. Intracoronary Acetylcholine Provocation Testing - Omission of the 20-\u00b5g Dose Is Feasible in Patients Without Coronary Artery Spasm in the Other Coronary Artery. Circulation Journal : Official Journal of the Japanese Circulation Society. 2016; 80: 1820\u20131823.","DOI":"10.1253\/circj.CJ-16-0344"},{"key":"ref106","doi-asserted-by":"publisher","unstructured":"Okuya Y, Saito Y, Kitahara H, Kobayashi Y. Relation of Vasoreactivity in the Left and Right Coronary Arteries During Acetylcholine Spasm Provocation Testing. The American Journal of Cardiology. 2024; 219: 71\u201376.","DOI":"10.1016\/j.amjcard.2024.03.020"},{"key":"ref107","doi-asserted-by":"publisher","unstructured":"Toleva O, Smilowitz NR, Quesada O, Kesarwani M, Savage MP, Prasad M, et al. Current Evidence-Based Treatment of Angina With Nonobstructive Coronary Arteries (ANOCA). Journal of the Society for Cardiovascular Angiography & Interventions. 2025; 4: 102633.","DOI":"10.1016\/j.jscai.2025.102633"},{"key":"ref108","doi-asserted-by":"publisher","unstructured":"Sueda S, Sakaue T. The Need for Separate Testing with Acetylcholine for the Assessment of Endothelial Dysfunction and Coronary Artery Spasm. European Cardiology. 2024; 19: e17.","DOI":"10.15420\/ecr.2022.16"},{"key":"ref109","doi-asserted-by":"publisher","unstructured":"Ang DTY, Berry C, Kaski JC. Phenotype-based management of coronary microvascular dysfunction. Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology. 2022; 29: 3332\u20133340.","DOI":"10.1007\/s12350-022-03000-w"},{"key":"ref110","doi-asserted-by":"publisher","unstructured":"Jansen TPJ, Konst RE, de Vos A, Paradies V, Teerenstra S, van den Oord SCH, et al. Efficacy of Diltiazem to Improve Coronary Vasomotor Dysfunction in ANOCA: The EDIT-CMD Randomized Clinical Trial. JACC. Cardiovascular Imaging. 2022; 15: 1473\u20131484.","DOI":"10.1016\/j.jcmg.2022.03.012"},{"key":"ref111","doi-asserted-by":"publisher","unstructured":"Escaned J, Mej\u00eda-Renter\u00eda H. Two legs to stand on: why acetylcholine testing should be considered along with wire-based tests in the diagnosis of non-obstructive myocardial ischaemia. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2022; 18: e611\u2013e613.","DOI":"10.4244\/EIJ-E-22-00031"},{"key":"ref112","doi-asserted-by":"publisher","unstructured":"Smilowitz NR, Prasad M, Widmer RJ, Toleva O, Quesada O, Sutton NR, et al. Comprehensive Management of ANOCA, Part 2-Program Development, Treatment, and Research Initiatives: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2023; 82: 1264\u20131279.","DOI":"10.1016\/j.jacc.2023.06.044"},{"key":"ref113","doi-asserted-by":"publisher","unstructured":"Frier R, Ohadi L, Amenedor K, Hariyanto J, Jones L, Toleva O, et al. 26-a-17257-acc baseline angiographic analysis of patients with ischemia and nonobstructive coronary arteries: insights from the discover inoca registry. Journal of the American College of Cardiology. 2026; 87: A420.","DOI":"10.1016\/j.jacc.2026.02.1032"},{"key":"ref114","doi-asserted-by":"publisher","unstructured":"Shah SM, Tremmel JA, Henry TD, Smilowitz NR, Prasad M, Kobayashi Y, et al. Determining the Cause of Coronary Vasomotor Disorders in Patients With Ischemia and Nonobstructive Coronary Arteries: Design and Rationale of the DISCOVER INOCA Prospective, Multicenter Registry. Journal of the Society for Cardiovascular Angiography & Interventions. 2024; 3: 102046.","DOI":"10.1016\/j.jscai.2024.102046"},{"key":"ref115","doi-asserted-by":"publisher","unstructured":"Shin ES, Ann SH, Singh GB, Lim KH, Yoon HJ, Hur SH, et al. OCT-Defined Morphological Characteristics of Coronary Artery Spasm Sites in Vasospastic Angina. JACC. Cardiovascular Imaging. 2015; 8: 1059\u20131067.","DOI":"10.1016\/j.jcmg.2015.03.010"},{"key":"ref116","doi-asserted-by":"publisher","unstructured":"Nishi T, Kume T, Yamada R, Okamoto H, Koto S, Yamashita M, et al. Layered Plaque in Organic Lesions in Patients With Coronary Artery Spasm. Journal of the American Heart Association. 2022; 11: e024880.","DOI":"10.1161\/JAHA.121.024880"},{"key":"ref117","doi-asserted-by":"publisher","unstructured":"Seligman H, Patel SB, Alloula A, Howard JP, Cook CM, Ahmad Y, et al. Development of artificial intelligence tools for invasive Doppler-based coronary microvascular assessment. European Heart Journal. Digital Health. 2023; 4: 291\u2013301.","DOI":"10.1093\/ehjdh\/ztad030"},{"key":"ref118","doi-asserted-by":"publisher","unstructured":"Ahmad A, Shelly-Cohen M, Corban MT, Murphree DH Jr, Toya T, Sara JD, et al. Machine learning aids clinical decision-making in patients presenting with angina and non-obstructive coronary artery disease. European Heart Journal. Digital Health. 2021; 2: 597\u2013605.","DOI":"10.1093\/ehjdh\/ztab084"},{"key":"ref119","doi-asserted-by":"publisher","unstructured":"Wang G, Guan L, Li S, Qin Y, Wang Y, Li X, et al. Explainable-enhanced AI for diagnosing coronary microvascular dysfunction with multimodal imaging. iscience. 2025; 28: 114101.","DOI":"10.1016\/j.isci.2025.114101"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/9\/10.31083\/RCM52151","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:58:01Z","timestamp":1790693881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/9\/10.31083\/RCM52151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":119,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026]]}},"alternative-id":["S2153-8174(26)03891-0"],"URL":"https:\/\/doi.org\/10.31083\/rcm52151","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"52151"}}