We read with interest the Ideas and Opinions article by De Servi and colleagues, who question the current emphasis on invasive coronary function testing (CFT) in patients with angina with no obstructive coronary arteries (ANOCA) and suspected microvascular angina (MVA), and propose a shift toward identifying “vulnerable” non-obstructive plaques (eventually by coronary CT angiography and radiomics/AI) and treating selected lesions with preventive percutaneous coronary intervention (PCI) [1]. We agree that atherosclerotic burden and plaque vulnerability are highly relevant in ANOCA/INOCA and that prevention deserves a central role.
