How Can You Have a Myocardial Infarction Without Significant Coronary Artery Disease? Whither MINOCA

This may seem a simple question that a medical student might ask on a ward round but, like all fundamental questions, the answer is much more complex. Indeed, the attending cardiologist on the ward round may respond with (a) it's not a myocardial infarction (MI); (b) it's missed obstructive coronary artery disease (CAD); (c) minor atherosclerotic CAD is responsible; (d) non-atherosclerotic mechanisms such as spasm are involved; or, (e) I am not certain, since we need more research! Even more disquieting is what the patient is told and the formal diagnosis included in the discharge letter, since both will have an important impact on patient care.