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Multimodality Imaging in a Patient With MINOCA and Anomalous Coronary Artery

Ignazio Alessio Gueli1, Giancarlo Trimarchi1, Michele Coceani2

  • 1Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy.

JACC. Case Reports
|June 27, 2025
PubMed

Insights

Myocardial infarction with nonobstructive coronary arteries (MINOCA) can stem from coronary anomalies. Multimodal imaging, including coronary computed tomography angiography and cardiac magnetic resonance, is vital for diagnosing MINOCA and guiding treatment.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Medical Case Study

Background:

  • Myocardial infarction with nonobstructive coronary arteries (MINOCA) presents a diagnostic challenge due to its heterogeneous nature.
  • Accurate diagnosis and management of MINOCA necessitate a multimodal imaging approach.
  • Identifying the specific etiology of MINOCA is critical for effective treatment strategies.

Observation:

  • A 60-year-old male with hypertension and no prior coronary artery disease experienced angina.
  • Initial investigations revealed septal ischemia and an anomalous septal artery with an interarterial course via coronary computed tomography angiography (CCTA).
  • A subsequent non-ST-segment elevation myocardial infarction was diagnosed, with cardiac magnetic resonance confirming infarction and prior CCTA suggesting acute occlusion of the anomalous septal artery.

Findings:

  • Coronary angiography demonstrated no obstructive coronary artery disease.
  • Multimodal imaging, including CCTA and cardiac magnetic resonance, identified an anomalous septal artery as the likely cause of MINOCA.
  • The case highlights the importance of evaluating coronary anomalies in MINOCA.

Implications:

  • This case emphasizes the crucial role of multimodal imaging in the diagnosis and management of MINOCA.
  • Coronary computed tomography angiography and cardiac magnetic resonance are complementary tools for elucidating MINOCA etiologies.
  • Recognizing coronary anomalies in MINOCA patients can lead to optimized patient management and improved outcomes.
Abstract

Keywords:
angiographyanomalous coronary arteriescardiac magnetic resonancecoronary computed tomography angiographymyocardial infarction with nonobstructive coronary arteriessingle photon emission computed tomography

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