The Complex Chest Pain and Coronary Microvascular Program focuses on understanding why some patients continue to experience chest pain and reduced blood flow to the heart even when major coronary arteries appear normal. By combining expertise in coronary physiology, advanced diagnostic testing, and cardiovascular research, the program evaluates problems affecting the heart’s smallest blood vessels, known as coronary microvascular dysfunction, as well as related conditions that affect how these vessels open and close.
Nonobstructive coronary artery disease is a common finding in patients undergoing coronary angiography for angina or abnormal stress testing. Many of these individuals have angina with nonobstructive coronary arteries (ANOCA), ischemia with nonobstructive coronary arteries (INOCA), or myocardial infarction with nonobstructive coronary arteries (MINOCA). A significant proportion of these patients have coronary microvascular dysfunction or coronary vasomotor abnormalities that are not identified through routine cardiovascular testing alone.
The program supports advanced physiologic evaluation of coronary microvascular and endothelial function, with a focus on improving recognition of underdiagnosed mechanisms of chest pain and ischemia. This work contributes to a growing body of evidence showing that coronary microvascular dysfunction is associated with adverse cardiovascular outcomes, persistent symptoms, and increased healthcare utilization when left unrecognized.
Established in 2022, the program reflects a highly specialized area of cardiovascular expertise at Banner – University Medical Center Tucson and the Sarver Heart Center. It is the first program of its kind in Arizona dedicated to advanced coronary reactivity testing and physiologic assessment of coronary microvascular dysfunction, bringing to Tucson capabilities more commonly associated with large academic referral centers.
In addition to its role in advancing cardiovascular evaluation, the program supports fellowship education and clinical investigation in coronary physiology, microvascular angina, endothelial dysfunction, and related ischemic syndromes. Ongoing registries and research efforts are helping generate new insights into diagnosis, outcomes, and the broader impact of coronary microvascular disease.
The program focuses on advanced evaluation of coronary microvascular dysfunction and related causes of persistent chest pain.
Program Themes
Coronary Microvascular Dysfunction
Advancing understanding of coronary microvascular and endothelial abnormalities that contribute to persistent chest pain, ischemia, and cardiovascular risk in patients without obstructive coronary disease.
Advanced Coronary Physiology
Applying specialized coronary reactivity testing and physiologic assessment to better define microvascular dysfunction, endothelial dysfunction, and vasomotor disorders.
Academic Referral-Level Expertise
Building a distinctive program in Arizona with capabilities typically concentrated in major academic cardiovascular centers, while expanding access to advanced coronary physiologic evaluation.
Research and Outcomes
Supporting registries, abstracts, and scholarly work focused on coronary microvascular disease, ischemia with nonobstructive coronary arteries, and the long-term implications of vasomotor dysfunction.
Education and Training
Providing unique educational opportunities for interventional cardiology fellows and trainees in coronary physiology, invasive assessment, and the evolving science of microvascular angina.
Program Leadership
The program is led by Michel T. Corban, MD, Associate Professor of Medicine, whose work focuses on coronary microvascular dysfunction, endothelial function, and invasive coronary physiology. Dr. Corban trained in this area at Mayo Clinic in Rochester and helped establish advanced coronary reactivity testing capabilities in Tucson. Under Dr. Corban’s leadership, the program has expanded the Sarver Heart Center’s work in coronary physiology, created new opportunities for fellow education, and strengthened research efforts related to ANOCA, INOCA, MINOCA, and coronary endothelial dysfunction.
Michel T. Corban, MD
Associate Professor, Medicine
Division of Cardiology