Doralisa Morrone, Giulio Stefanini, Marco De Carlo, Cristina Giannini, Gabor Toth, Dan Prunea, Carlo Zivelonghi, Alice Benedetti, Bernard De Bruyne, Adriaan Wilgenhof, Jan Kaňovský, Petr Kala, Lene Holmvang, Markus Hasbak, David Hildick-Smith, James Cockburn, Nicolas Amabile, Aurélie Veugeois, T. Hovasse, Antoinette Neylon, B. Honton, Bruno Farah, Tommaso Gori, Maike Knorr, Alexander Wolf, Thomas J. Schmit, Jörg Hausleiter, Konstantin Stark K, Mohamed Abdel-Waha, Hans-Josef Feistritzer, Felix Woitek, Axel Linke, J Leick, Shazia Afzal, Dimitrios Alexopoulos, Charalampos Varlamos, K Tsioufis, Kyriakos Dimitriadis, Luca Testa, Mattia Squillace, Federico Conrotto, Fabrizio D’Ascenzo, Gianluca Campo, Marta Cocco, Carlo Di Mario, Flavia Caniato, F. Ribichini, Daniele Prati, G Tarantini, Francesco Cardaioli, Francesco Burzotta, Lazzaro Paraggio, Francesco Bedogni, Luca Arzuffi, Alaide Chieffo, Giulia Ghizzoni, Giedrius Davidavičius, Povilas Budrys, Nicolas Van Mieghem, Joost Daemen, Regine Brinkmann, Hendrik Bante, Maciej Lesiak, Sylwia Iwanczyk, Jerzy Pregowski, Jaroslaw Skowronski, Sergio Madeira, Luís Raposo, Rodrigo Estévez-Loureiro, Antonio Sisinni, Javier Escaned, Adrián Jerónimo, Raúl Moreno, Santiago Jiménez-Valero, Pieter A. Vriesendorp, Tobias Pustjens, Robert van Geuns, Peter Damman, Tim P. van de Hoef, P Pim van der Harst, Mamas A. Mamas, Simon Duckett, Ghada Mikhail, Carla Lucarelli, C. Berry, R De Caterina
BACKGROUND AND AIMS: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities requiring further investigation to assess prognosis and guide treatment. We evaluated current diagnostic practices across European academic centres in its diagnosis and management, to focus on current gaps in clinical practice. METHODS: Between June and October 2023, we distributed an electronic survey to 42 centres selected from a 2023 list of European Association of Percutaneous Cardiovascular Interventions Hosting Academic Centres, obtaining information on demographics of MINOCA, perceived clinical impact, testing and treatments. RESULTS: The analysis was based on data from 41 centres. According to the survey, MINOCA accounts for approximately 10% of MI cases. Only 38% of the respondents perceived MINOCA as increasing the risk for future major adverse cardiovascular events. Sixty-three percent of centres agreed on the need for further testing after MINOCA diagnosis, and 22% reported proceeding with a comprehensive diagnostic algorithm. Intravascular (51%) and cardiac magnetic resonance imaging (50%) were the most common diagnostic tools used. Coronary plaque disruption was perceived as the most frequent cause based on respondents' opinions. Sixty-nine percent of centres considered 'empiric' therapy acceptable without functional testing. CONCLUSIONS: This survey revealed a significant heterogeneity in the diagnostic approaches to MINOCA in academic European centres, with variable belief of its clinical impact, wide variation in diagnostic algorithms, noteworthy diagnostic inertia, and poor adherence to guideline recommendations. All these point to a pressing need for a unified approach to MINOCA testing and a much closer alignment to guidelines.