The DISCOVER INOCA Prospective Multi-center Registry

Inclusion Criteria:

• Suspected ischemic heart disease and is referred to undergo clinically indicatedinvasive coronary angiography

• No obstructive coronary artery disease (CAD) as defined by operator visualassessment with (1) angiographically normal coronary arteries OR (2) non-obstructiveCAD with angiographic stenosis < 50%, or greater than or equal to 50 but < 70% withFFR greater than or equal to 0.81 or RFR greater than or equal to 0.90

• Willing to comply with specified follow-up evaluations. The participant or legallyauthorized representative has been informed of the nature of the study, agrees toits provisions, and has been provided written informed consent approved by theappropriate Institutional Review Board (IRB) or Ethics Committee (EC)

Exclusion Criteria:

• Pregnant or nursing

• Any myocardial infarction at index presentation or within 90 days prior toenrollment, defined as any electrocardiogram diagnostic for myocardial infarction ORelevation in serum troponin greater than the upper limit of the site-definedreference range

• Known left ventricular ejection fraction < 50% or cardiogenic shock requiringpressors or mechanical circulatory assistance (e.g., intra-aortic balloon pump, leftventricular assist device, other temporary cardiac support blood pump)

• Renal insufficiency, defined as estimated glomerular filtration rate (eGFR) <30mL/min/1.73 m2 (by the Modification of Diet in Renal Disease equation) or dialysisat the time of screening

• Prior percutaneous coronary intervention

• Planned percutaneous coronary intervention (PCI)

• Prior coronary artery bypass graft surgery

• Prior ST-elevation myocardial infarction

• History of hypertrophic cardiomyopathy

• History of infiltrative heart disease (e.g., cardiac amyloidosis)

• New York Heart Association Class IV congestive heart failure

• Severe mitral regurgitation

• Severe aortic stenosis

• Severe pulmonary hypertension (Mean pulmonary artery pressure greater than or equalto 35mmHg or echocardiographic right ventricular systolic pressure greater than orequal to 60mmHg)

• Known history of unrepaired or repaired congenital heart disease

• Past or pending heart transplant, or on the waiting list for organ transplant

• Known other medical illness or known history of substance abuse that may causenon-compliance with the protocol, or is associated with a life expectancy of lessthan 1 year

• Current or planned participation in a study of an investigational therapy

• Angiographic stenosis in any major epicardial vessel ≥ 70% by visual estimate

• Angiographic stenosis in any major epicardial vessel greater than or equal to 50%and < 70% by visual estimate with FFR less than or equal to 0.80 or RFR less than orequal to 0.89