Work

Heterogeneity in the diagnostic management of MINOCA: a UK clinician survey

Year: 2026

Type: article

Abstract: Background Myocardial injury with non-obstructive coronary arteries (MINOCA) accounts for around one in ten hospitalisations with acute myocardial infarction. Despite guideline recommendations, diagnostic and management approaches vary. We aimed to characterise current UK practice for the investigation and treatment of patients with MINOCA.Methods We conducted a cross-sectional online survey of UK clinicians involved in MINOCA care between March and December 2025. To provide clinical context, two clinical vignettes with probable non-ischaemic (Case A) and ischaemic (Case B) aetiologies were used to assess investigation preferences, with agreement documented using a Likert scale from 0 to 5 and reported as the proportion agreeing or strongly agreeing (score 4 or 5). General management questions and free-text responses underwent thematic analysis by two independent reviewers.Results Of 146 respondents, 140 provided demographic data. Most were cardiology consultants (76/140, 54.3%) from tertiary centres (74/140, 52.9%). Echocardiography received high endorsement across both vignettes (Case A: 93/99 (93.9%) vs Case B: 86/88 (97.7%) agreeing or strongly agreeing). Cardiac magnetic resonance (CMR) imaging preferences differed between vignettes: 83/101 (82.2%) agreed or strongly agreed with CMR for the younger patient with viral prodrome versus 38/86 (44.2%) for the older patient with atheroma (p<0.001). Hyperaemic (adenosine) coronary microvascular function testing was endorsed by 14/100 (14.0%) and 18/88 (20.5%), respectively, and no respondent endorsed acetylcholine provocation testing in either vignette. Thematic analysis identified four themes: context-dependence of decisions, uncertainty regarding diagnostic utility, psychological burden on patients and concerns about MINOCA terminology.Conclusions UK clinicians demonstrate considerable variation in the investigation of patients with MINOCA, with clinical presentation strongly influencing recommendations for CMR imaging. Although the vignettes differed in several clinical features, the extent of variation in investigation preferences highlights the absence of a standardised diagnostic approach. These findings support the need for evidence-based care pathways incorporating refined case definitions and more precise terminology.

Source: Open Heart

DOI: 10.1136/openhrt-2026-004551