Cardiovascular disease remains the leading cause of death worldwide [1], yet the field’s diagnostic and treatment strategies continue to target obstructive epicardial coronary artery disease primarily. This approach leaves a large and increasing group of patients inadequately treated: those with myocardial ischemia or infarction whose coronary angiograms show no flow-limiting blockages. Three related but distinct conditions, ischemia with non-obstructive coronary arteries (INOCA), myocardial infarction with non-obstructive coronary arteries (MINOCA), and Takotsubo syndrome (TTS), now present a significant clinical challenge.
