Case report demonstrates multimodality imaging resolving acute infarction in a patient with MINOCA, highlighting the combined diagnostic value of cardiac MRI and CCTA.
BACKGROUND: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous condition requiring multimodal imaging for accurate diagnosis and management. Identifying the underlying etiology is crucial for guiding treatment. CASE SUMMARY: A 60-year-old man with hypertension and no prior coronary artery disease presented with angina. Single-photon emission computed tomography revealed ischemia in the mid-basal septum, and coronary computed tomography angiography (CCTA) identified an anomalous septal artery with an interarterial course. Three years later, he was admitted with non-ST-segment elevation myocardial infarction. Coronary angiography showed no obstructive lesions, but cardiac magnetic resonance confirmed a recent infarction in the mid-septum. A retrospective review of prior CCTA suggested acute occlusion of the anomalous septal artery. DISCUSSION: This case underscores the role of multimodal imaging in MINOCA, particularly in patients with coronary anomalies. TAKE-HOME MESSAGE: CCTA and cardiac magnetic resonance are complementary in identifying the underlying cause of MINOCA and optimizing patient management.
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Gueli et al. (2025) studied this question.
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