Why the study?
Coronary culprit lesions occur in 45% of patients with MINOCA, but multivessel OCT is infrequently performed, leaving uncertain whether interventional cardiologists can identify culprit lesions using invasive coronary angiography alone.
Does visual assessment of invasive coronary angiography accurately identify culprit lesions compared to multivessel OCT in women with MINOCA?
Population
64 women with MINOCA and OCT-identified culprit lesions
Comparison
Angiographic identification before vs after ECG and transthoracic echocardiography review against OCT reference
Design
Blinded diagnostic accuracy study
Key result
Invasive coronary angiography correctly identified the OCT-defined culprit artery in only 54.7% (95% CI 42.6-66.3%) of women with MINOCA, and accuracy did not improve with ECG and TTE review.
Authors
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Angiography may miss OCT-defined culprits in MINOCA; leaves open whether routine multivessel imaging improves diagnosis or outcomes in women.
Observational (n=64)
Blinded to OCT findings
Does visual assessment of invasive coronary angiography accurately identify culprit lesions compared to multivessel OCT in women with MINOCA?
Invasive coronary angiography alone is insufficient to reliably identify culprit lesions in women with MINOCA, highlighting the need for multivessel intracoronary imaging.
Shwayder et al. (2026) conducted an observational in Myocardial infarction with nonobstructive coronary arteries (MINOCA) (n=64). Invasive coronary angiography vs. Multivessel optical coherence tomography (OCT) was evaluated on Identification of the culprit artery by at least 1 interventional cardiologist (95% CI 42.6-66.3). Invasive coronary angiography correctly identified the OCT-defined culprit artery in only 54.7% (95% CI 42.6-66.3%) of women with MINOCA, and accuracy did not improve with ECG and TTE review.