Coronary disease & ACSDiagnostic or prognostic study
Multimodality Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women and Men
- Prospective diagnostic study
- international
- multicentre (28 sites)
- core laboratory blinded interpretation
- CMR completed in 284 (85%)
Authors' conclusion
The combination of multivessel coronary OCT and CMR in patients with a clinical diagnosis of MINOCA confirmed myocardial infarction in 59% and identified an alternate cause (MINOCA mimic) in 20%. Clinical factors had limited usefulness to predict imaging abnormalities. No sex differences in imaging results were detected.
Study context
- Population
- Patients with clinical diagnosis of MI and nonobstructive coronary arteries (myocardial infarction with nonobstructive coronary arteries (MINOCA)), 28 sites in the US, Canada and UKMINOCA with optical coherence tomography (OCT)
- Participants
- 336 patients
- Comparison
- Multivessel coronary OCT and CMR in MINOCA, women vs men
- Womenn = 270
- Menn = 66
- Outcome
- Underlying causes of MINOCA by multivessel coronary OCT and CMR
Performance
As reported in the abstract
Cause of the clinical presentation (both tests completed)
- Cause identified
- 79%
- Ischemic cause of MINOCA
- 59%
- Non-ischemic mimicking condition
- 20%
- OCT alone found MINOCA etiology
- 151 of 336 (45%)
- CMR alone found MINOCA etiology
- 180 of 284 (63%)
Further findings
OCT-defined culprit lesion
P = 0.18
CMR ischemic pattern
P = 0.12
CMR nonischemic pattern
P = 0.78
- OCT-defined culprit lesion — Overall
- 45%
- CMR ischemic pattern — Overall
- 114 of 284 (40%)
- CMR nonischemic pattern — Overall
- 23%
Predictors of imaging abnormalities
- OCT culprit lesion predictors: age, abnormal angiogram, number of vessels imaged; culprit lesion in normal angiograms
- 27%
- Abnormal CMR predictors: peak troponin, shorter time to CMR, non-Asian race; abnormal CMR with troponin <4-fold above upper reference limit
- 40%
Original publication
Multimodality Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women and Men. Circulation. Published 28 March 2026. doi:10.1161/circulationaha.126.080234
Summarised from the published abstract; every number is checked against it