When people think about a heart attack, they usually imagine blocked arteries. This is the most common cause, where fatty deposits build up and stop blood from reaching the heart. However, not all heart attacks happen this way.
Some patients have heart attack symptoms and abnormal blood tests, but their arteries look normal. This condition is called myocardial infarction with non-obstructive coronary arteries, or MINOCA.
For many years, MINOCA has confused both doctors and patients. People may feel severe chest pain and be told they had a heart attack, but standard tests cannot explain why. This uncertainty can be frightening, especially for younger patients or women who may not fit the typical profile of heart disease.
A new study led by researchers at NYU Grossman School of Medicine offers an important breakthrough. The research, published in the journal Circulation, shows that combining two advanced imaging techniques can identify the cause of these heart attacks in most cases.
The study is one of the largest to focus on MINOCA. Researchers examined 336 patients across 28 hospitals in the United States, Canada, and the United Kingdom. The average age was 58, and most participants were women. This reflects the fact that MINOCA is more common in women than in men.
To understand what was happening in these patients, doctors used two different imaging methods. The first is called optical coherence tomography, or OCT.
This test involves placing a small device inside the arteries to take very detailed images of the artery walls. It can detect problems that are too subtle to be seen in standard scans, such as tiny tears or small blood clots.
The second method is cardiac magnetic resonance imaging, or MRI. This test provides clear images of the heart muscle. It can show where damage has occurred and whether it is caused by reduced blood flow, inflammation, or other conditions.
When these two tests were used together, the results were very clear. Doctors were able to find the likely cause of the heart problem in 79% of patients. This is a major improvement compared to traditional methods.
The study found that about 59% of patients actually had a true heart attack caused by reduced blood flow. This could be due to small plaque buildup, artery spasms, or clotting.
Another 20% had conditions that look like heart attacks but have different causes. These include inflammation of the heart muscle, known as myocarditis, and stress-related heart conditions such as takotsubo syndrome.
This distinction is very important. Different causes require different treatments. Without accurate diagnosis, patients may not receive the care they need.
The findings also showed that doctors cannot rely on symptoms or basic tests to decide which patients need advanced imaging. Even patients with mild signs could have significant heart damage. This means that using both imaging techniques may be necessary for most patients with this condition.
The study was presented at the American College of Cardiology’s Annual Scientific Session and published in Circulation.
These findings have important implications for patient care. They support current guidelines that recommend additional imaging, but now provide strong evidence to back them up. They also highlight the limits of standard tests, which may miss important details.
However, there are some limitations. The study required specialized equipment and expertise, which may not be available in all hospitals. More research is needed to make these techniques more accessible and to develop treatment plans based on the specific causes found.
Overall, this study represents a major step forward. It shows that heart attacks are more complex than once thought and that better tools can help doctors provide clearer answers.
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Source: NYU Grossman School of Medicine.
