In this exchange, Vijay Kunadian and Javier Escaned explore the real-world implementation of INOCA (Ischemia with Non-Obstructive Coronary Arteries) and ANOCA (Angina with Non-Obstructive Coronary Arteries) diagnostic pathways. Drawing on the 2024 CCS (Chronic Coronary Syndromes) guidelines, and the EAPCI consensus document, they discuss why these conditions remain underdiagnosed—and how structured invasive assessment can make a difference, even in time-constrained clinical environments.

This conversation offers practical insights for improving patient care by refining diagnosis and treatment strategies in cases where traditional imaging may fall short.

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