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June 30, 2026MedicinaOpen Access

Diagnostic Advancements in MINOCA: Do They Translate to a Better Clinical Outcome? A Review of the Literature

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Key result

Advanced imaging like CMR reclassifies the diagnosis in ~67% of MINOCA cases for personalized therapy.

Why the study?

MINOCA carries substantial morbidity and mortality, underscoring the need for accurate aetiological characterisation and tailored therapy using advanced imaging modalities.

Do advanced imaging modalities improve diagnosis, prognostic stratification, and therapeutic guidance in patients with MINOCA?

Population

Patients with MINOCA

Design

Literature review

Authors

MBMaria BozikaAAAnastasiοs ApostolosKNKassiani-Maria Nastouli

Discussion

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Overview

May support mechanism-guided MINOCA therapy; leaves open prospective trials on outcomes.

Key Points

  • This review aims to evaluate the role of advanced imaging in diagnosing and managing MINOCA.
  • Literature review of advanced imaging modalities including CMR, OCT, and IVUS.
  • Assessment of imaging's prognostic value and impact on treatment strategies for MINOCA patients.
  • Discussion of the PROMISE trial outcomes regarding imaging-guided treatment.
  • Two-thirds of MINOCA cases reclassified using CMR, distinguishing true ischemic conditions from mimics.
  • Abnormal findings from OCT and IVUS linked to higher major adverse cardiovascular events.
  • PROMISE trial suggests imaging-guided treatment positively impacts angina status and quality of life.

Structured PICO

Do advanced imaging modalities improve diagnosis, prognostic stratification, and therapeutic guidance in patients with MINOCA?

P
Population
Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA)
E
Exposure
Advanced imaging modalities (cardiac magnetic resonance imaging [CMR], optical coherence tomography [OCT], intravascular ultrasound [IVUS], Coronary Computed Tomography Angiography [CCTA]) and invasive functional testing

Advanced imaging modalities such as CMR, OCT, and IVUS are essential for identifying the specific underlying mechanisms of MINOCA, thereby enabling personalized, mechanism-guided therapy.

Limitations

  • Need for further randomized trials to support broader integration of these modalities into routine practice

Cite This Study

Bozika et al. (2026) conducted a review in Myocardial infarction with non-obstructive coronary arteries (MINOCA). Advanced imaging modalities (CMR, OCT, IVUS, invasive functional testing) was evaluated. Advanced cardiac imaging modalities, such as CMR, reclassify the working diagnosis in up to two-thirds of MINOCA cases, transforming it into a mechanism-based syndrome for personalized therapy.

synapsesocial.com/papers/6a435c8c759b888809a52ffahttps://doi.org/10.3390/medicina62071243
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Pathophysiology and diagnostic pathway of myocardial infarction with non-obstructive coronary arteries2023 · 20 citations
  2. 2Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography2021 · 42 citations
  3. 3Hidden Infarctions: Understanding and Managing Myocardial Infarction with Non-Obstructive Coronary Arteries Through a Multimodal Lens2026
  4. 4The Role of Imaging for MINOCA (Myocardial Infarction with No Obstructive Coronary Artery Disease): a Review of Literature and Current Perspectives2020 · 11 citations
  5. 5MINOCA: A Working Diagnosis2023 · 9 citations