The value of imaging: Exams provide important answers when women have unexplained heart attacks

Diagnostic imaging can help identify the cause of heart attacks in women who do not have blocked arteries, according to new findings presented at the American Heart Association’s Scientific Sessions 2020 virtual meeting.

The study’s authors tracked the value of ordering two additional imaging examinations—coronary optical coherence tomography (OCT) and cardiac MRI—when women experience a myocardial infarction with non-obstructive coronary arteries (MINOCA) and have already undergone an angiogram. More than 300 women with a median age of 60 years old were enrolled in the analysis. None of the women had a prior history of obstructive coronary artery disease.

“Our findings are important because women (or men) with MINOCA have historically been told that since the angiogram is OK, they never had a heart attack,” lead author Harmony Reynolds, MD, associate professor of medicine at the NYU Grossman School of Medicine, said in a statement. “This is entirely wrong for about two-thirds of the women who had both imaging tests, and misleading for one-quarter of the women because we found they had another problem that was not related to blood flow and could be diagnosed via cardiac MRI.”

For 84% of study participants, coronary OCT and cardiac MRI helped identify why the myocardial infarction had occurred. For a majority of those women, the additional exams helped identify signs of heart damage related to reduced blood flow. Myocarditis was another common culprit.

“Our findings demonstrate that even if the angiogram does not show substantial artery blockage, when women have symptoms and blood test findings consistent with a heart attack, it is likely a true heart attack and not heart inflammation,” Reynolds added. “Additional imaging tests can get to the root of the problem and help health care professionals make an accurate heart attack diagnosis for women and to ensure they receive timely treatment.”

Women are three times more likely than men to have a MINOCA, the authors added. These difficult-to-diagnosis incidents are also more prominent among non-white patients than white patients.

AHA Scientific Sessions 2020 is scheduled for Nov. 13-17, 2020. More information on this virtual event is available here.