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Review Article Volume 19 Issue 1
Myocardial infarction with non-obstructive coronary arteries (MINOCA): current concepts in pathophysiology, diagnosis, management, and prognosis
Mehmet Murat ŞAHİN, Abdullah SARIHAN, Abdülmelik BİRGÜN, Ömer Burak ÇELİK, Macit KALÇIK, Mehmet Mustafa YILMAZ, Mucahit YETİM, Muhammet Cihat ÇELİK, Lütfü BEKAR, Yusuf KARAVELİOĞLU
Received: January 15, 2026 | Published: February 5, 2026
Citation: ŞAHİN MM, SARIHAN A, BİRGÜN A, et al. Myocardial infarction with non-obstructive coronary arteries (MINOCA): current concepts in pathophysiology, diagnosis, management, and prognosis. J Cardiol Curr Res. 2026;19(1):13-21. DOI: 10.15406/jccr.2026.19.00637
Abstract
Myocardial infarction with non‑obstructive coronary arteries (MINOCA) describes a heterogeneous clinical syndrome in which patients fulfill diagnostic criteria for acute myocardial infarction despite the absence of obstructive coronary artery disease on angiography. Once considered an uncommon and relatively benign condition, MINOCA is now recognized as a clinically significant entity associated with substantial morbidity and non‑negligible mortality. Its diagnostic and therapeutic complexity stems from the wide spectrum of underlying mechanisms, including atherosclerotic plaque disruption, coronary vasomotor disorders, microvascular dysfunction, coronary thromboembolism, and spontaneous coronary artery dissection, as well as the frequent coexistence of myocardial conditions that mimic ischemic injury. Accurate evaluation of MINOCA requires a paradigm shift from an angiography‑centered approach to a mechanism‑oriented framework. Multimodality imaging plays a central role in this process, with cardiac magnetic resonance imaging enabling tissue‑level characterization and differentiation between ischemic and non‑ischemic myocardial injury, and intravascular and functional coronary testing allowing detection of occult coronary pathology. This structured diagnostic strategy facilitates etiological classification in a substantial proportion of patients and provides the foundation for individualized management. Therapeutic decision‑making in MINOCA remains challenging due to limited randomized evidence and marked biological heterogeneity. While selected patients benefit from conventional secondary prevention strategies, others require tailored treatments targeting vasospasm, microvascular dysfunction, thromboembolic sources, or dissection‑related pathology. Prognosis varies considerably according to the underlying mechanism, underscoring the importance of accurate diagnosis and long‑term risk stratification. Future advances will depend on precision phenotyping, standardized diagnostic pathways, and dedicated clinical trials to inform evidence‑based, mechanism‑ specific care.
Keywords: myocardial infarction with non-obstructive coronary arteries, atherosclerotic plaque disruption, coronary vasospasm, coronary microvascular dysfunction, coronary thromboembolism, spontaneous coronary artery dissection, intravascular imaging (OCT, IVUS), cardiac magnetic resonance imaging, multimodality diagnostic strategy, mechanism-based management, prognosis and long-term outcomes
©2026 ŞAHİN, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.