{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T06:52:29Z","timestamp":1793083949849,"version":"4.5.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities requiring further investigation to assess aetiology. The European Society of Cardiology guidelines recommend advanced tests to establish an underlying mechanism. We evaluated advanced diagnostic testing utilization and real-world adherence to the current guideline in an international MINOCA registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>DOMINO is a prospective, multicentre, non-commercial registry enrolling 365 patients with MINOCA across 17 centres in 13 countries. Advanced testing was defined as cardiac magnetic resonance (CMR), intracoronary imaging, and\/or invasive coronary functional assessment. The association between advanced testing and diagnostic resolution was assessed by multivariable logistic regression, with standard, cluster-robust, and generalized estimating equation (GEE) approaches to account for clustering by centre. Guideline-directed testing was performed in 254\/365 (69.6%) and varied markedly by country (0\u2013100%, P &amp;lt; 0.0001). A specific etiologic diagnosis was reached in 337\/365 patients (92.3%). Advanced testing was associated with diagnostic resolution in the standard and GEE models, with a directionally consistent but non-significant cluster-robust estimate [standard odds ratio (OR) 3.94, 95% confidence interval (CI) 1.59\u201310.06; cluster-robust OR 3.75, 95% CI 0.95\u201314.72, P = 0.058; GEE OR 3.69, 95% CI 1.04\u201313.11]. Diagnostic resolution increased progressively with the extent of testing performed, from 85.6% with no advanced testing to 97.1% with CMR plus invasive\/functional assessment (trend P = 0.02). Discharge pharmacotherapy varied significantly by etiologic diagnosis (P = 0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Advanced diagnostic testing was associated with a higher likelihood of a determined etiologic diagnosis in MINOCA, despite marked international variability in its use; however, this association is partly definitional, as advanced testing directly contributes to diagnostic ascertainment for several etiologic categories. These findings nonetheless support closing the guideline-practice gap in advanced testing, while underscoring the need to distinguish mechanistically confirmed diagnoses from presumptive ones.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag422","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:16:52Z","timestamp":1786965412000},"source":"Crossref","is-referenced-by-count":1,"title":["The DiagnOsis of MINOCA (DOMINO) registry: a real-world use of multimodality imaging and its impact on etiologic classification"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9667-6931","authenticated-orcid":false,"given":"Doralisa","family":"Morrone","sequence":"first","affiliation":[{"name":"Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa ,","place":["Italy"]},{"name":"Azienda Ospedaliero-Universitaria Pisana, Cisanello University Hospital Cardiology Unit 1, , Via Paradisa 2, Pisa 56124, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5589-6059","authenticated-orcid":false,"given":"Mattia","family":"Alberti","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa ,","place":["Italy"]},{"name":"Azienda Ospedaliero-Universitaria Pisana, Cisanello University Hospital Cardiology Unit 1, , Via Paradisa 2, Pisa 56124, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6758-0772","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Cravo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Lisbon University, CCUL@RISE, University Hospital ULS Santa Maria , Lisbon ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2356-3848","authenticated-orcid":false,"given":"Mar\u00eda Jes\u00fas","family":"Espinosa Pascual","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario Getafe , Getafe ,","place":["Spain"]},{"name":"Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid , Villaviciosa de Od\u00f3n ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4360-5897","authenticated-orcid":false,"given":"Joaqu\u00edn Jes\u00fas","family":"Alonso Mart\u00edn","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario Getafe , Getafe ,","place":["Spain"]},{"name":"Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid , Villaviciosa de Od\u00f3n ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4721-3236","authenticated-orcid":false,"given":"Vlatka","family":"Reskovic Luksic","sequence":"additional","affiliation":[{"name":"University of Zagreb School of Medicine, University Hospital Centre Zagreb , Zagreb ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8964-6144","authenticated-orcid":false,"given":"Jadranka","family":"Separovic Hanzevacki","sequence":"additional","affiliation":[{"name":"University of Zagreb School of Medicine, University Hospital Centre Zagreb , Zagreb ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamze","family":"Babur G\u00fcler","sequence":"additional","affiliation":[{"name":"University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arda","family":"G\u00fcler","sequence":"additional","affiliation":[{"name":"University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristopher","family":"Knott","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St George\u2019s University Hospitals NHS Foundation Trust, London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2751-7391","authenticated-orcid":false,"given":"Cornelia","family":"Margineanu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St George\u2019s University Hospitals NHS Foundation Trust, London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merc\u00e8","family":"Roqu\u00e9","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cl\u00ednic Cardiovascular Institute, Hospital Cl\u00ednic, University of Barcelona, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8924-740X","authenticated-orcid":false,"given":"Marie-Annick","family":"Clavel","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec Department of Medicine, , Qu\u00e9bec City ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8547-3004","authenticated-orcid":false,"given":"Tomas","family":"Cieza","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec Department of Medicine, , Qu\u00e9bec City 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Ioannina ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Pappas","sequence":"additional","affiliation":[{"name":"University Hospital of Ioannina Cardiology Department, , Ioannina ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9267-1478","authenticated-orcid":false,"given":"Christina","family":"Karamarkou","sequence":"additional","affiliation":[{"name":"Elisabeth Krankenhaus Essen Cardiology Department, , Essen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7333-3701","authenticated-orcid":false,"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Gimelli","sequence":"additional","affiliation":[{"name":"Fondazione Toscana Gabriele Monasterio\/CNR Cardiolgy Department, , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0016-9538","authenticated-orcid":false,"given":"Danilo","family":"Neglia","sequence":"additional","affiliation":[{"name":"Fondazione Toscana Gabriele Monasterio\/CNR Cardiolgy Department, , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1637-574X","authenticated-orcid":false,"given":"Raffaele","family":"De Caterina","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa ,","place":["Italy"]},{"name":"Azienda Ospedaliero-Universitaria Pisana, Cisanello University Hospital 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