This ESC working group position paper establishes a standardized diagnostic algorithm for MINOCA, strongly recommending routine CMR imaging to determine the specific aetiology and enable tailored therapy.
Myocardial infarction with non-obstructive coronary arteries is a heterogeneous entity with a prevalence of 1?13% of all patients with a clinical diagnosis of AMI. There are several potential aetiologies that should be elucidated by a commonly agreed diagnostic algorithm, proposed herein. Rational treatment follows from an aetiologic diagnosis, since therapy that may be appropriate for one cause (e.g. anticoagulation for thromboembolism or calcium channel blockers for vasospasm) will not be appropriate for all MINOCA patients. In MINOCA patients without an obvious aetiology after initial evaluation including echocardiography, we recommend a routine examination with CMR imaging. Multi-centre clinical trials of diagnostic and therapeutic strategies are needed. These results will have great impact on both treatment and prognosis of these patients.
Agewall et al. (2016) studied this question.