NSTEMI MINOCA: clinical-instrumental characterization of a heterogeneous clinical enigma

Abstract Background The nosology of angiographically non-critical coronary myocardial infarction (MINOCA) with the presentation of NSTEMI represents a challenge for the clinician due to the lack of a clear definition of this entity, which is often interpreted as a transitional diagnosis awaiting a more precise investigation. Purpose The aim of the study was to investigate the epidemiological, clinical and prognostic characteristics of MINOCA with NSTEMI presentation, comparing it with a population of type 2 (T2) NSTEMI to identify significant clinical-instrumental and outcome predictors. Methods In this single-centre retrospective observational study, 18223 undergoing invasive coronary angiography were screened from 2005 to 2022. After a review of angiographic data and clinical presentation, 538 patients were included, of which 301 were classified as MINOCA and 237 as T2 NSTEMI following guidelines. The primary outcome was defined as a composite of death, non-fatal AMI, non-fatal transitory ischemic attack or stroke, and hospitalization for heart failure. Results After stratification by diagnosis, patients with MINOCA were younger than those with T2 NSTEMI (66.33 ± 11.67 vs 70.55 ± 10.94 years, respectively, p