Perspective:

This study showed that 6% of patients with MINOCA developed a new MI during mean follow-up of 4.3 years. Of these, 60% underwent cardiac catheterization and nearly half had obstructive coronary disease. The authors concluded that progression of obstructive CAD is common and that repeat angiogram is warranted. Since this is an observational study, the clinical decision to send a patient for cardiac catheterization rather than to continue with medical management would have influenced the findings. The patients with recurrent MI were older, had more diabetes and hypertension, and had lower ejection fraction. The study design prevented differentiation between those with normal coronary arteries (0% stenosis) and mild CAD (1-50% stenosis), but this would be an important distinction in future studies because MINOCA can result from various etiologies. Further differentiation would be helpful for determining long-term prognosis and medical therapy. Thus, in the appropriate clinical setting, it may be important and beneficial to consider coronary angiography in patients presenting with recurrent MI after a prior diagnosis of MINOCA.