What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA) (n=198). Intervention: Diagnostic evaluation including advanced cardiovascular imaging. Primary outcome: Main causes of MINOCA.

What does this research mean for the field?

40.9% of patients with MINOCA had no established cause for acute myocardial infarction despite comprehensive diagnostic imaging efforts. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The research aims to identify the primary causes of MINOCA and assess the utility of advanced imaging methods.

February 6, 2026

Main causes of MINOCA and an analysis of diagnostic challenges: based on a regional registry of 198 patients from a tertiary cardiology hospital

Key Result

In a cohort of 198 patients with MINOCA, 40.9% had no established cause for AMI despite coronary angiography in all patients and cardiac magnetic resonance in 41.2%.

Key Points

The research aims to identify the primary causes of MINOCA and assess the utility of advanced imaging methods.
Single-centre cohort study involving 198 patients with diagnosed AMI and no significant coronary lesions.
Data collection included medical records and follow-up over five years.
Advanced imaging techniques evaluated included cardiac magnetic resonance, coronary computed tomography angiography, and myocardial perfusion scintigraphy.
40.9% of patients had no established cause for their AMI.
Causes of MINOCA were diagnosed as coronary artery disease in 15.7%, thrombus/embolism in 13.1%, and coronary dissection in 12.1%.
Advanced imaging such as CMR was done in 41.2% of cases, while OCT and IVUS were rarely used.

Study Design

Type

Cohort (n=198)

Multicenter

Structured PICO

Population

198 patients with Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA), defined as AMI with no coronary stenosis ≥ 50% and no other clinically evident specific cause, from a single tertiary cardiology centre.

Outcome

Main causes of MINOCA and the use of advanced cardiovascular imaging modalities

A significant proportion of MINOCA patients remain without a definitive etiologic diagnosis, highlighting the potential underutilization of advanced intracoronary imaging and provocative testing.

Abstract

Abstract Introduction The occurrence of acute myocardial infarction (AMI) without significant coronary artery lesions has been discussed in the literature for at least 85 years. However, the term MINOCA (Myocardial Infarction with Nonobstructive Coronary Arteries) is more recent, and the available literature remains scarce. Its diagnosis is challenging, as it requires the exclusion of various differential diagnoses, often necessitating the use of advanced cardiovascular imaging modalities. Objective To assess the main causes of MINOCA and the use of advanced cardiovascular imaging modalities, based on a dataset of 198 patients with MINOCA from a tertiary cardiology centre. Methods In this single-centre cohort, all patients met the following diagnostic criteria: (1) AMI, as defined by (a) no coronary stenosis ≥ 50% in any artery potentially related to the infarction and (b) no other clinically evident specific cause for the acute presentation. Data collection and follow-up were conducted over five years, including a total of 198 patients. Information was obtained from medical records, focusing on the main causes of MINOCA and the use of advanced cardiovascular imaging techniques, such as cardiac magnetic resonance (CMR), coronary computed tomography angiography (CCTA), myocardial perfusion scintigraphy (MPS), optical coherence tomography (OCT), and intravascular ultrasound (IVUS). Results Among the 198 patients with a suggestive MINOCA presentation, 40.9% had no established cause for AMI. The remaining cases were attributed to coronary artery disease (CAD) 50% in 15.7%, thrombus/embolism in 13.1%, coronary dissection in 12.1%, and, less frequently (10% individually), vasospasm, aneurysm/ectasia, myocardial bridge, and type 2 AMI. Coronary angiography was performed in all patients. CMR was performed in 41.2% of patients, CCTA in 5.6%, and MPS in 25.8%. Advanced intracoronary imaging techniques, such as OCT and IVUS, were used in only 1% and 1.5% of cases, respectively. No provocative testing was performed. Despite coronary angiography being conducted in all patients and CMR being performed in nearly half of the cohort, 40.9% of cases remained without a definitive cause for AMI. Conclusion Diagnosing and determining the underlying cause of MINOCA remains a challenge, despite the use of advanced cardiovascular imaging techniques. As a result, a considerable number of patients remain without an established cause, which negatively impacts the ability to provide individualised treatment. Greater use of techniques such as OCT/IVUS or even provocative tests might reduce the number of cases without a definitive diagnosis.

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