{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:19:26Z","timestamp":1790709566342,"version":"4.1.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2021,2,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 6% to 15% of myocardial infarctions (MIs) and disproportionately affects women. Scientific statements recommend multimodality imaging in MINOCA to define the underlying cause. We performed coronary optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) imaging to assess mechanisms of MINOCA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this prospective, multicenter, international, observational study, we enrolled women with a clinical diagnosis of myocardial infarction. If invasive coronary angiography revealed &lt;50% stenosis in all major arteries, multivessel OCT was performed, followed by CMR (cine imaging, late gadolinium enhancement, and T2-weighted imaging and T1 mapping). Angiography, OCT, and CMR were evaluated at blinded, independent core laboratories. Culprit lesions identified by OCT were classified as definite or possible. The CMR core laboratory identified ischemia-related and nonischemic myocardial injury. Imaging results were combined to determine the mechanism of MINOCA, when possible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 301 women enrolled at 16 sites, 170 were diagnosed with MINOCA, of whom 145 had adequate OCT image quality for analysis; 116 of these underwent CMR. A definite or possible culprit lesion was identified by OCT in 46.2% (67\/145) of participants, most commonly plaque rupture, intraplaque cavity, or layered plaque. CMR was abnormal in 74.1% (86\/116) of participants. An ischemic pattern of CMR abnormalities (infarction or myocardial edema in a coronary territory) was present in 53.4% (62\/116) of participants undergoing CMR. A nonischemic pattern of CMR abnormalities (myocarditis, takotsubo syndrome, or nonischemic cardiomyopathy) was present in 20.7% (24\/116). A cause of MINOCA was identified in 84.5% (98\/116) of the women with multimodality imaging, higher than with OCT alone (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) or CMR alone (\n                      <jats:italic>P<\/jats:italic>\n                      =0.001). An ischemic cause was identified in 63.8% of women with MINOCA (74\/116), a nonischemic cause was identified in 20.7% (24\/116) of the women, and no mechanism was identified in 15.5% (18\/116).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Multimodality imaging with coronary OCT and CMR identified potential mechanisms in 84.5% of women with a diagnosis of MINOCA, 75.5% of which were ischemic and 24.5% of which were nonischemic, alternate diagnoses to myocardial infarction. Identification of the cause of MINOCA is feasible and has the potential to guide medical therapy for secondary prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT02905357.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.120.052008","type":"journal-article","created":{"date-parts":[[2020,11,14]],"date-time":"2020-11-14T13:20:07Z","timestamp":1605360007000},"page":"624-640","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":284,"title":["Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women"],"prefix":"10.1161","volume":"143","clinical-trial-number":[{"clinical-trial-number":"nct02905357","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-0655","authenticated-orcid":true,"given":"Harmony R.","family":"Reynolds","sequence":"first","affiliation":[{"name":"Sarah Ross Soter Center for Women\u2019s Cardiovascular Research (H.R.R., N.R.S., A.H., E.H., J.S.H.), New York University Grossman School of Medicine, NY."},{"name":"Leon H. Charney Division of Cardiology, Department of Medicine (H.R.R., N.R.S., A.H., B.S., M.A., S.B., L.R., J.S.H.), New York University Grossman School of Medicine, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Maehara","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Foundation, New York, NY (A.M., M.M., Z.A.A.)."},{"name":"Columbia University, New York, NY (A.M., N.J., Z.A.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond Y.","family":"Kwong","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Boston, MA (R.Y.K., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Sedlak","sequence":"additional","affiliation":[{"name":"Vancouver General Hospital, British Columbia, Canada (T.S., J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7027-984X","authenticated-orcid":true,"given":"Jacqueline","family":"Saw","sequence":"additional","affiliation":[{"name":"Vancouver General Hospital, British Columbia, Canada (T.S., J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel R.","family":"Smilowitz","sequence":"additional","affiliation":[{"name":"Sarah Ross Soter Center for Women\u2019s Cardiovascular Research (H.R.R., N.R.S., A.H., E.H., J.S.H.), New York University Grossman School of Medicine, NY."},{"name":"Leon H. Charney Division of Cardiology, Department of Medicine (H.R.R., N.R.S., A.H., B.S., M.A., S.B., L.R., J.S.H.), New York University Grossman School of Medicine, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehtisham","family":"Mahmud","sequence":"additional","affiliation":[{"name":"University of California San Diego Health, La Jolla (E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Wei","sequence":"additional","affiliation":[{"name":"Barbra Streisand Women\u2019s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.W., N.B.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Marzo","sequence":"additional","affiliation":[{"name":"New York University Winthrop Hospital, New York University Long Island School of Medicine, Mineola (K.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2082-0247","authenticated-orcid":true,"given":"Mitsuaki","family":"Matsumura","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Foundation, New York, NY (A.M., M.M., Z.A.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8051-6119","authenticated-orcid":true,"given":"Ayako","family":"Seno","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Boston, MA (R.Y.K., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anais","family":"Hausvater","sequence":"additional","affiliation":[{"name":"Sarah Ross Soter Center for Women\u2019s Cardiovascular Research (H.R.R., N.R.S., A.H., E.H., J.S.H.), New York University Grossman School of Medicine, NY."},{"name":"Leon H. 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