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Aims Adenosine has been tested in several randomized controlled trials (RCTs) to minimize the incidence of coronary microvascular obstruction (CMVO). The aim of this study was to pool all the RCTs comparing intracoronary or intravenous adenosine versus placebo in patients with acute coronary syndrome (ACS) undergoing myocardial revascularization. Methods and results PubMed and Scopus electronic databases were scanned for eligible studies up to 5th June 2022. A total of 26 RCTs with 5843 patients were included. Efficacy endpoints were major adverse cardiac events (MACE), all-cause death, non-fatal myocardial infarction, and heart failure. Atrioventricular blocks and ventricular fibrillation/sustained ventricular tachycardia (VF/SVT) were the safety endpoints. Myocardial blush grade, thrombolysis in myocardial infarction (TIMI) flow grade, left ventricular ejection fraction (LVEF), infarct size, and ST-segment resolution were also assessed. Adenosine administration was not associated with any clinical benefit in terms of MACE, all-cause death, non-fatal myocardial infarction, and heart failure. However, adenosine was associated with an increased rate of advanced atrioventricular blocks and of VF/SVT in studies with total mean ischaemic time >3 h, compared to placebo. Remarkably, among patients undergoing percutaneous coronary intervention, adenosine was associated with reduced myocardial blush grade 0–1 and TIMI flow grade 0–2, compared to placebo. Furthermore, adenosine did not show favourable effects on LVEF and infarct size. Conclusion Adenosine infusion, as adjunctive therapy in ACS, was associated with an increased risk of advanced atrioventricular blocks and increased rates of adenosine-triggered ventricular arrhythmias in patients with long ischaemic time, without providing any clinical benefit compared to placebo.

Background Percutaneous coronary intervention (PCI) is the milestone of treatment for patients with acute coronary syndrome (ACS). However, a considerable number of patients do not achieve a complete myocardial reperfusion since coronary microvascular obstruction (CMVO) might occur. Adenosine is one of the pharmacological strategies tested in several randomized controlled trials (RCTs) to minimize the incidence of CMVO. However, conflicting results have been reported so far. The aim of the present study was to evaluate all the RCTs comparing intracoronary or intravenous adenosine versus placebo as adjunctive therapy in patients with ACS undergoing PCI or thrombolysis. Methods PubMed and Scopus electronic databases were scanned for eligible studies up to June 5th, 2022. Our meta-analysis included 26 randomized RCTs with a total of 5843 patients involved. Primary endpoints were the rate of clinical events, defined as major adverse cardiovascular events (MACE), heart failure (HF), all-cause-death and non-fatal myocardial infarction (MI). The rate of advanced atrioventricular (AV) blocks and ventricular fibrillation/sustained ventricular tachycardia (VF/SVT) were considered as safety endpoints. Further subgroup analyses and meta regressions were conducted to evaluate the role of different procedural and non-procedural factors influencing the results. Finally, a secondary analysis was conducted only including RCTs enrolling patients with ST-segment elevation myocardial infarction (STEMI). Results Adenosine administration did not confer any significant clinical benefit in terms of reduction of MACE (RR 0.91 CI 0.79-1.05, p 0.16), all-cause-death (RR 0.90 CI0.74-1.09, p 0.28), non-fatal MI (RR 1 CI 0.74 - 1.35, p 0.44) and HF (RR 0.94 CI 0.77-1.16, p 0.59). Remarkably, adenosine was associated with a significant reduction of post-procedural CMVO parameters such as Myocardial Blush Grade (MBG) 0-1 (RR 0.69 CI 0.53-0.90, p 0.01) and Thrombolysis In Myocardial Infarction (TIMI) flow grade 0-2 (RR 0.67 CI 0.53-0.85, p 3 hours (RR 1.67 CI 1.14-2.42) Conclusions This is the most up-to-date meta-analysis summarizing the available evidence on adenosine safety and efficacy in the prevention or treatment of CMVO in ACS patients. Although adenosine improves surrogate parameters of myocardial perfusion, its use does not provide any clinical benefits. Additionally, adenosine infusion increases the risk of advanced AV blocks. Moreover, a longer ischemic time seems to be associated with a higher rate of adenosine-triggered ventricular arrhythmias, suggesting that higher myocardial ischemic damage may represent a substrate for adenosine arrhythmogenic effects.

Background Chronic coronary total occlusions (CTO) are considered an emerging predictor of ventricular arrhythmias (VAs) but currently there are only few data on arrhythmic outcomes in patients affected by CTO undergoing radiofrequency catheter ablation of VAs. Objective This study sought to evaluate the impact of unrevascularized CTO on the recurrence of VAs after catheter ablation. Methods This was a single-center retrospective study that enrolled 120 patients, between 2015 and 2020. All patients were admitted for ventricular tachycardia (VT) or high premature ventricular contractions (PVCs) burden (>25% detected by Holter ECG), without evidence of acute coronary syndrome; they underwent coronary angiography, electrophysiology (EP) study and three-dimensional electroanatomic mapping (3D-EAM) followed by VAs ablation. Results Twenty-eight patients (23%) of 120 patients showed CTO at coronary angiography. At baseline, CTO group presented with higher prevalence of hypertension, chronic renal disease, systolic ventricular dysfunction, secondary prevention ICD implantation, higher rate of low abnormal activities by 3D-EAM compared to the non-CTO group. At a median follow-up of 15 months (range 1-96 months) after catheter ablation, the only independent predictor of VAs recurrence was the presence of moderate to severe left ventricular (LV) dysfunction (p=0.02). Conclusion The presence of CTO does not predict VAs recurrence after catheter ablation which is instead predicted by LV dysfunction.

Background and aims Worldwide, air pollution is the fourth leading cause of death. Both brief and long-term exposures to air pollution have been associated with marked increases in cardiovascular-related morbidity and mortality. Previous studies have focused on the short-term influence of particulate pollutants on ventricular arrhythmia (VA) development, primarily expressed as 24-hour Holter ECG monitoring arrhythmic burden or as presentation as life-threatening ventricular arrhythmias. The aim of our study was to investigate the association between air pollutant exposure and VA burden in remotely-monitored patients. Methods We enrolled retrospectively 86 patients carriers of implantable cardioverter-defibrillators (ICD), loop recorders (ILR) or pacemaker devices with remote monitoring via CarelinkTM Medtronic or Merlin.netTM PCN Abbott softwares. Intracavitary and ILR tracings were reviewed by EP personnel at our centre to define VA burden and the number of appropriate shocks and ATPs occurred in 2021. Demographic and clinical characteristics (e.g. cardiovascular history, ejection fraction, smoking, antiarrhythmic drugs (AADs)) were collected through telephone interviews. Each patient's residential and working address were used to obtain information on pollutant exposure in the years 2017-2021 in terms of annual mean concentrations of PM10, PM2.5, ozone, sulfur dioxide, carbon dioxide, carbon monoxide and benzene, as determined by European Environmental Agency air quality reports. The primary endpoint was a composite of ventricular fibrillation, sustained and nonsustained ventricular tachycardia, appropriate ATP or shocks in patients with various levels of air pollutants exposure. Results Of 86 patients (58 male, mean age 63.2±18.7 years) enrolled in this study, 44 (51.6%) had received an ICD, 32 of whom (37.2%) with a primary prevention indication. 31 patients (36.1%) had been receiving at least one AAD. History of coronary artery disease (CAD) was present in one third of the study population and baseline mean EF was 49.8±13.8%. VA events occurred in 17 patients (19.8%), all with a significantly lower baseline EF (40.3±12.2% vs 51.5±13.5% p=0.005). Average mean values of benzene concentration in the previous 4 years were significantly higher in patients suffering from a VA event (1.64±0.82 μg/m3 vs 1.12±0.48 μg/m3, p=0.001), as were PM2.5 values (11.64±1.98 vs 10.74±1.28 μg/m3, p=0.023). A weak but positive correlation was found between median PM2.5 concentration, benzene and VAs (p=0.023, p=0.001 respectively). A multivariate regression model was built, including long-term exposure to benzene and PM2.5 and baseline EF, and it would explain 29.8% of the variance in VAs, correctly classifying 78.1% of cases. Conclusions This study was the first to evaluate the relationship between long-term exposure to a wide array of air pollutants and VAs in a European population. In our sample, we found a weak but significant correlation between a higher chronic exposure to benzene and recorded VA events. Possible mechanisms may include oxidative stress and a direct, nonspecific membrane action due to benzene lipophilic properties. Hence, we highlighted the possible role of outdoor benzene exposure in ventricular arrhythmogenesis for the first time, a finding that requires validation through subsequent studies aimed at elucidating the role of air pollution as a ubiquitous, potentially modifiable, population-based risk factor.

Background Several therapeutic strategies are available for cancer patients, leading to a longer life expectancy; however, each drug might have different side effects, which increase morbidity and mortality. Cardiovascular diseases are one of the most frequent and dramatic of these side effects, leading to interruption of a potentially lifesaving treatment or hesitating into heart failure. Clinical Case A 50 year-old female with recent diagnosis of breast cancer presented to our Emergency Department (ED) for asthenia, vomiting and dyspnea. A first dose of epirubicin and cyclophosphamide as neoadjuvant chemotherapy (CT) was administered three days before the onset of symptoms. Screening echocardiogram performed before starting the CT showed normal systolic ejection fraction, normal diastolic function and no valvular disease. At ED admission, the patient presented hypotension, tachycardia, sweating and mental confusion. The ECG showed sinus tachycardia with diffuse ST segment elevation and diffuse low QRS voltages. Echocardiogram proved severe left dysfunction (LVEF 15%) with low cardiac output (LVOT VTI 6 mm) and elevated ventricular filling pressure (E/e’ 26). EAB showed severe hyperlactacidemia. The diagnosis of cardiogenic shock was done and high doses of dobutamine and noradrenaline were started. Laboratory values confirmed multiorgan involvement, in absence of any signs of inflammation and infection. The coronary angiography performed revealed normal coronary arteries and elevated left ventricular end-diastolic pressure (LVEDP 29 mmHg). Despite pharmacological therapy, the patient's condition worsened so we proceeded to IMPELLA CP implantation and started methylprednisolone 10 mg/kg for three days with subsequent tapering doses. After 24 hours, we obtained hemodynamic stability and hyperlactacidemia clearance. Unfortunately, myelotoxicity and marked piastrinopenia (until 16 000*10 9/L) complicated the clinical course; for this reason, we stopped unfractionated Heparin (UHF) and no anticoagulant therapy, other the one in purge solution, was performed. CMR revealed diffuse signal enhancement during the T2w sequences associated with a global enhancement of T2 Mapping values due to general edema, a global intramyocardial strengthening, a significant enhancement of the T1 mapping values and extracellular volume were described at the delayed enhancement sequences. The hemodynamic conditions progressively improved during the hospitalization and the IMPELLA pump was removed. Serial echocardiograms documented an improvement of the ejection fraction and further mild reduction of ventricular filling pressure (E/e’ 8) normal right ejection fraction and initial inferior vena cava collapsibility. All the inotropic supports were suspended; we introduced beta-blocker, ACE-inhibitors, subsequently replaced with sacubitril/valsartan, well tolerated. Conclusion Acute cardiotoxicity with possible life-threatening conditions regardless of the basal cardiovascular risk class is a rare clinical condition, but needs further investigation. Future researches are warranted to determine the molecular mechanisms underlying cardiotoxicity to contain the side effects, maximize the benefit of the oncological therapy and, when necessary, select the best therapeutic option.

Aims The guide extension catheter (GEC) is a helpful tool to increase catheter support when facing complex percutaneous coronary intervention (PCI) in unfavorable coronary anatomies. The aim of this study was to describe indication, efficacy, and safety of the GEC in a high-volume center. Methods and results From 2014 to 2021, we retrospectively identified and analyzed 351 interventional cases in which GEC was used to complete the procedure. The endpoints of the study were PCI success, procedural success and device failure. GEC use increased over the years and was more frequently used by radial approach (92.1%) in elective setting (90.6%) and using the 6F size (95.3%). The GEC was mostly implemented as bail-out strategy (75.9%) with the aim to improve back-up (89.6%), less frequently to optimize catheter alignment or obtain selective coronary cannulation (10.4%). Intracoronary advancement was performed using the guidewire in 1.3% of cases, after positioning of a second “buddy” wire in 23.2%, with support of a deflated balloon at the distal tip in 12.2%, or with anchoring technique in 63.3%. Mean coronary deep intubation depth was 38.8±23.9mm. Vessel and lesion characteristics are reported in Table I. Overall, PCI success rate was 92.5%, while procedural success (PCI success without in hospital adverse event) was 88.6%. GEC was successfully used in 92.7% of patients with no device-dependent severe adverse events; in particular, failures were related to inability to cross the target lesion in 4.5% or to device–related complication in 2.85% of cases. Conclusions This large real-world registry on GEC use in complex PCI confirms the GEC as a valid and safe tool to increase backup support and overcome the limits of conventional technique during complex PCI.

Background Coronary vasomotor abnormalities are important causes of myocardial ischemia in patients with non-obstructive coronary artery disease (NOCAD). However, the role of air pollution in determining coronary vasomotor disorders has never been investigated. Objectives We aimed to evaluate the association between long-term exposure to particulate matter 2.5 (PM2.5) and 10 (PM10), and coronary vasomotor disorders in NOCAD patients. Methods Patients with myocardial ischemia and NOCAD undergoing coronary angiography and intracoronary provocation test with acetylcholine (ACh) were prospectively studied. Both patients with chronic myocardial ischemia (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA) were enrolled. Based on each case's home address, exposure to PM2.5 and PM10 was assessed. Results We included 287 patients (median age 62.0 years [52.0-70.0], 149 [51.9%] males): 161 (56.1%) INOCA and 126 (43.9%) MINOCA. One hundred seventy-six patients (61.3%) had positive provocation test. Exposure to PM2.5 and PM10 was higher in patients with a positive provocation test (p Conclusions Higher exposure to PM2.5 and PM10 in patients with myocardial ischemia and NOCAD is associated with coronary vasomotor abnormalities. In particular, PM2.5 is an independent risk factor for the occurrence of epicardial spasm and MINOCA as clinical presentation.

Childhood cancer survival has improved significantly in the past few decades, reaching rates of 80% or more at 5 years. However, with improved survival, early- and late-occurring complications of chemotherapy and radiotherapy exposure are becoming progressively more evident. Cardiovascular diseases (CVD) represent the leading cause of non-oncological morbidity and mortality in this highly vulnerable population. Therefore, the necessity of reliable, non-invasive screening tools able to identify cardiac complications early is now preeminent in order to implement prevention strategies and mitigate disease progression. Echocardiography, with recently introduced three-dimensional evaluation and strain imaging, may allow identification of myocardial dysfunction, pericardial complications and valvular heart disease. However, additional imaging modalities may be necessary in selected cases. This manuscript provides an in-depth review of non-invasive imaging parameters studied in childhood cancer survivors. Furthermore, we will illustrate brief surveillance recommendations according to available evidence and future perspectives in this expanding field.

Chronic coronary total occlusions (CTO) are considered an emerging predictor of ventricular arrhythmias (VAs), but currently there are few data on arrhythmic outcomes in patients affected by CTO undergoing radiofrequency catheter ablation of VAs. This study sought to evaluate the impact of unrevascularized CTO on the recurrence of VAs after catheter ablation. This was a single-center retrospective study enrolling 120 patients between 2015 and 2020. All patients were admitted for ventricular tachycardia (VT) or high premature ventricular contractions burden (>25% detected by Holter ECG), without evidence of acute coronary syndrome; they underwent coronary angiography, electrophysiology (EP) study, and three-dimensional electroanatomic mapping (3D-EAM) followed by VAs ablation. Twenty-eight patients (23%) of 120 patients showed CTO at coronary angiography. At baseline, the CTO group presented with higher prevalence of hypertension, chronic renal disease, systolic ventricular dysfunction, secondary prevention ICD implantation, and higher rate of LAVA by 3D-EAM compared with the non-CTO group. At a median follow-up of 15 months (range 1–96 months) after catheter ablation, the only independent predictor of VAs recurrence was the presence of moderate to severe left ventricular (LV) dysfunction. Therefore, the presence of CTO does not predict VAs recurrence after catheter ablation, which is instead predicted by LV dysfunction.

Body image is a multidimensional construct that encompasses perceptions about body size, emotions, and cognition about physical appearance. Obese identity is related to body image in the lifetime, and according to scientific literature body image dissatisfaction among obese patient persist after bariatric surgery. The objective of this review is to examine the body image changes in patients with obesity pre-and post-bariatric surgery. We have carried out a systematic review of literature on PubMed. Initially, 169 publications have been identified, but in total, in compliance with inclusion and exclusion criteria, 15 studies have been analyzed. According to the examined literature, body image does not change after bariatric surgery. These patients will be difficult to adapt for a new body, because there is a persistent obese view of self. Furthermore, ex-obese patients are dissatisfied with the excessive skin after bariatric surgery. Excessive body weight, and negative self-image are replaced with dissatisfaction with excessive skin, and the factors associated with body image stability are still unknown. Literature examination raises the issue of body image dissatisfaction, but does not explain why it varies so widely across bariatric patients. Obese identity is related to body image across the lifetime and is an important factor of post-surgical outcomes. Longitudinal studies based on ideal body image pre- and post- bariatric surgery and evidence-based controlled studies on psychotherapeutic treatment for body image dissatisfaction are strongly recommended. Psychotherapy could improve body image quality and wellbeing. Evidence obtained from: systematic reviews of experimental studies.

A pesquisa em tela, fazendo uso de uma metodologia de análise qualitativa, empregando os métodos de abordagem hipotético-dedutivos de caráter descritivo e analítico, em face de técnica de pesquisa bibliográfica, onde se visita a legislação, a doutrina e a jurisprudência, tem por fim analisar a viabilidade e pertinência do uso de técnicas de mediação como forma de pacificação dos conflitos na sociedade de informação, em especial, em razão da chamada online dispute resolution (ODR), tendo por atenção a presente realidade de decretação de calamidade pública, em decorrência da pandemia do COVID-19, que impossibilitou a presença física dos sujeitos da lide para as tratativas conciliatórias.

EnglishThe normative framework that covers the protective worker, which has the purpose of humanizing and ethical content to the social profit from the capitalist activity is constantly attacked by entrepreneurs seeking in every way to reduce costs with the basic rights/fundamental labor, the result of a historical process of constitutionalization. One of the subterfuges used has been the creation fraudulent labor cooperatives, in order to denature a true employment relationship where the employer simulate this relationship through a contract of service with the cooperative, which is a intermediate hand labor, against all tenets of cooperative axiological. Research on screen makes use of a methodology for qualitative analysis, using the methods of approach hypothetical-deductive, descriptive and analytical, with the background to analyze the new normative provisions of Law n.o 12,690 of 2012, which created the milestone regulatory cooperative work with aim to provide clarity on the legal relationship between the contractor and the contractor in order to distinguish the employment relationship and the relationship of service made by a cooperative, so as to discourage the abhorrent practice of coloring the cooperative. portuguesO arcabouco normativo protetivo que reveste o trabalhador, o qual possui a finalidade de humanizar e dar um conteudo etico social ao lucro proveniente da atividade capitalista, e constantemente atacado pelo empresariado que busca, de toda forma, reduzir os custos com os direitos basicos/fundamentais do trabalho, fruto de um processo historico de constitucionalizacao. Um dos subterfugios utilizados tem sido a constituicao fraudulenta de cooperativas de trabalho, com o fim de desnaturar um verdadeiro vinculo empregaticio, onde o empregador simularia essa relacao por meio de um contrato de prestacao de servico com a cooperativa de trabalho, sendo esta uma intermediaria de mao-de-obra, indo contra todos os postulados axiologicos do cooperativismo. A pesquisa em tela faz uso de uma metodologia de analise qualitativa, usando-se os metodos de abordagem hipotetico-dedutivos de carater descritivo e analitico, tendo por fundo analisar os novos enunciados normativos da Lei n.o 12.690 de 2012, que veio criar o marco regulatorio das cooperativas de trabalho com fito de proporcionar uma clareza na relacao juridica entre o contratante e o contratado de forma a distinguir a relacao empregaticia e a relacao de prestacao de servico feito por uma cooperativa, de sorte a desestimular a pratica odiosa do desvirtuamento do cooperativismo.

Takotsubo syndrome (TS) is an acute and reversible form of myocardial stunning preceded by emotional or physical stress, not explained by an obstruction of an epicardial coronary artery as in acute coronary syndrome. Over the last decades, TS is receiving growing attention, leading to an increase in awareness and diagnostic rate. Chest pain and dyspnea are the most common presenting symptoms; however, nonspecific presentations make the diagnosis challenging for clinicians. Here, we present the case of a 76-year-old female who experienced two completely asymptomatic episodes of TS 20 years apart.

El artículo explora los proyectos de reforma política en el caso brasileño desde un aspecto inexplorado: las estrategias para maximizar las ganancias electorales inherentes a las propuestas de reforma electoral. Para ello, analizamos las Propuestas de Reforma Constitucional (PEC) presentadas en el Congreso Nacional sobre el tema de los 29 años de democracia brasileña y creamos una base de datos con 493 observaciones con 52 variables que agrupamos en 5 categorías de análisis. De la literatura (Benoit, 2007; Boix, 1999; Colomer, 2004, 2005, 2018) pretendemos inferir sobre los diseños propuestos en los PEC, evaluando las posibles ganancias y pérdidas estratégicas para las partes. Los resultados muestran que los PEC no parecen estar guiados por intereses estratégicos de las partes, como se predice en la literatura. Por el contrario, la investigación sugiere una racionalidad normativa (sin maximizar las ganancias).

Myocardial infarction with non-obstructive coronary artery (MINOCA) disease represents a heterogeneous clinical conundrum accounting for about 6% of all acute myocardial infarction (MI) cases. Initially believed to be a benign condition, is now becoming clear that MINOCA is associated with a non-negligible risk of mortality, rehospitalization, disability and angina burden at follow-up, with high socioeconomic costs. To date, there are no prospective clinical trials in this population and cannot be assumed that benefits observed in patients suffering from MI with obstructive coronary artery disease may successfully translate to this syndrome. Herein, we comment on the importance of the multimodality assessment to properly identify and treat the specific causes of MINOCA, in order to improve prognosis and the quality of life in these patients.

A pesquisa em tela, fazendo uso de uma metodologia de análise qualitativa, usando-se os métodos de abordagem hipotético-dedutivos de caráter descritivo e analítico, adotando-se técnica de pesquisa bibliográfica, onde se visita a legislação, a doutrina e a jurisprudência, tem por desiderato traçar um desenho dos principais pontos de um microssistema jurídico emergencial trabalhista, alicerçado no bojo da sistemática brasileira, em decorrência da pandemia do COVID-19, o qual se deu em face de uma hiper produção de documentos jurídicos, nessa temática, em específico, bem como vem por exigir uma análise quanto a sua adequação aos regramentos e principiologias constitucionais.

Electrical storm (ES) is a life-threatening condition that may lead to recurrent arrhythmias, need for ventricular mechanical support, and death. The study aimed to assess the burden of arrhythmia recurrence and in-hospital outcomes of patients admitted for ES in a large urban hospital. We performed a retrospective analysis of patients admitted with ventricular arrhythmias from January 2018 to June 2021 and identified 61 patients with ES, defined as 3 or more episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) within 24 hours. We reviewed the in-hospital outcomes and compared outcomes between patients who had no recurrence of VT/VF after the first 24 hours (34 [56%]), those with recurrence of 1 or 2 episodes of VT/VF within a 24-hour period (15 [24%]), and patients with 3 or more recurrent VT/VF events consistent with recurrent ES after the first 24 hours (12 [20%]). Patients with recurrent ES had significantly higher in-hospital mortality as compared with those with recurrent VT/VF not meeting criteria for ES or no recurrences of VT/VF (3 [25%] vs 0 [0%] vs 0 [0%]; p = 0.002). Moreover, patients with recurrent ES also had higher rates of the combined end points of ventricular mechanical support and death (7 [58%] vs 1 [6%] vs 1 [3%], p

Up to 4 million patients with signs of myocardial ischemia have no obstructive coronary artery disease (CAD). The absence of precise guidelines for diagnosis and treatment in non-obstructive CAD encourages the scientific community to fill the gap knowledge, to provide non-invasive and less expensive diagnostic tools. The aim of our study was to explore the biological profile of Ischemia with Non-Obstructive Coronary Arteries (INOCA) patients with microvascular dysfunction compared to patients presenting with obstructive chronic coronary syndrome (ObCCS) in order to find specific hallmarks of each clinical condition. We performed a gene expression array from peripheral blood mononuclear cells (PBMCs) isolated from INOCA (n = 18) and ObCCS (n = 20) patients. Our results showed a significantly reduced gene expression of molecules involved in cell adhesion, signaling, vascular motion, and inflammation in INOCA as compared to the ObCCS group. In detail, we found lower expression of Platelet and Endothelial Cell Adhesion Molecule 1 (CD31, p < 0.0001), Intercellular Adhesion Molecule-1 (ICAM1, p = 0.0004), Tumor Necrosis Factor (TNF p = 0.0003), Transferrin Receptor (TFRC, p = 0.002), and Vascular Endothelial Growth Factor A (VEGFA, p = 0.0006) in the INOCA group compared with ObCCS. Meanwhile, we observed an increased expression of Hyaluronidase (HYAL2, p < 0.0001) in INOCA patients in comparison to ObCCS. The distinct expression of molecular biomarkers might allow an early and non-invasive differential diagnosis between ObCCS and INOCA, improving clinical management and treatment options, in the era of personalized medicine.