This prospective single-center interventional study will include women with angina and non-obstructive coronary arteries. Participants will undergo a standardized invasive coronary assessment combining coronary physiology, acetylcholine provocation testing, and optical coherence tomography. The diagnostic protocol will identify functional and morphological mechanisms of angina, including microvascular dysfunction, epicardial vasospasm, microvascular spasm, endothelial dysfunction, functional epicardial disease, combined mechanisms, or normal coronary physiology.
Based on the identified phenotype, participants will receive individualized multidisciplinary treatment, including targeted pharmacological therapy, adapted cardiovascular rehabilitation, and psycho-emotional support when indicated. Clinical follow-up will be performed at 1, 6, and 12 months to assess angina symptoms, quality of life, functional capacity, adherence to treatment, and cardiovascular events.
Female participants aged 35 to 75 years.
Symptoms compatible with stable angina or suspected myocardial ischemia.
Non-obstructive coronary arteries, defined as absence of angiographic stenosis greater than or equal to 50%.
Ability to undergo invasive coronary assessment and clinical follow-up.
Significant structural heart disease.
Severe left ventricular systolic dysfunction, defined as left ventricular ejection fraction <40%.
Clinically relevant contraindication to adenosine or acetylcholine, including severe asthma, untreated high-grade atrioventricular block, or known hypersensitivity.
Active oncological disease or life expectancy less than 12 months.