Myocardial infarction with nonobstructive coronary arteries – the European PERspective (SNIPER) survey

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.