# Does the management of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) changes with advanced diagnostic workup beyond coronary angiography? Results from the “Evaluation of the clinical Profile, Investigations and Cardiac Imaging of the Patients with MINOCA (EPIC-MINOCA Study)”

## TL;DR

This study shows that advanced diagnostic tests beyond coronary angiography help identify causes and change treatment for patients with MINOCA.

## Contribution

The study demonstrates that advanced diagnostic workup improves diagnosis and management in MINOCA patients.

## Key findings

- Advanced workup identified possible causes in 16 patients versus 4 with limited workup.
- Management changed in 10 patients with advanced workup versus 3 with limited workup.
- Most patients (61.8%) had limited diagnostic testing to coronary angiography.

## Abstract

Evaluation of the patients with MINOCA and identifying the underlying aetiology remains challenging. However, investigation in most patients remains limited to coronary angiography (CAG). The study aimed to assess the clinical profile, investigations and cardiac imaging of the patients with MINOCA and its outcomes.

Out of 55 patients with MINOCA, CAG was normal in 16 (29.1%), while 39 (69.9%) had nonobstructive coronary artery disease. Of 55 patients, 34 had limited workup (Group 1) and only 21 had advanced workup (Group 2). In comparison to Group 1, Group 2 had a significantly higher association with the identification of possible underlying aetiology (16 vs. 4, p < 0.001) and a change in the management (10 vs. 3, p = 0.002).

Diagnostic workup in patients with MINOCA was limited to CAG in 61.8% of patients in this study. However, patients with advanced workup had a significantly higher association with the change in the treatment and identifying possible underlying aetiology in such patients.