Global Disparities in Diagnostic and Therapeutic Strategies for Myocardial Infarction With Non-obstructive Coronary Arteries: An International Survey
6 affiliations
- 1Department of Cardiology, Ibn Al-Bitar Cardiac Centre, Baghdad, Iraq.
- 2Department of Medicine, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq.
- 3Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq.
- 4Iraqi Scientific Council of Cardiology, Baghdad, Iraq.
- 5Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
- 6King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
Abstract
Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) requires multimodality evaluation, including cardiac magnetic resonance (CMR), intracoronary (IC) imaging, and coronary function testing (CFT). However, real-world uptake of these guideline-recommended modalities varies widely. We conducted a global survey to characterize practice variation in MINOCA evaluation and management across demographic characteristics, continents, and economic settings.
Methods: A 16-item online survey targeting cardiologists and cardiology trainees was distributed globally between August and December 2024. Respondents provided information on demographic characteristics, institutional context, and routine diagnostic and therapeutic strategies for MINOCA. Descriptive statistics, χ2 tests, and multiple regression analysis were used to assess associations.
Results: A total of 329 cardiology professionals from 6 continents participated (69.6% interventional cardiologists; 45.9% practicing in high-income countries [HIC]). Overall, 64.1% of respondents reported routine statin use and 55.6% reported beta-blocker use in MINOCA management. Advanced diagnostic modalities demonstrated substantial geographic variation. Europe reported the highest use of CMR (80.6%) and CFT (38.9%), whereas IC imaging was most frequently reported in North America (44.1%). Respondents from HIC reported greater routine use of CMR (56.3% vs 31.6%), IC imaging (41.7% vs 28.9%), and CFT (31.1% vs 13.2%) compared with those from lower-income settings (all P < .01). In multivariable analyses, HIC status remained the strongest independent predictor of routine CMR use (odds ratio [OR], 3.95; 95% CI, 2.34-6.68), IC imaging use (OR, 3.01; 95% CI, 1.74-5.20), and CFT use (OR, 2.29; 95% CI, 1.26-4.14). Academic or teaching hospital affiliation was independently associated with higher CMR use (OR, 2.19; 95% CI, 1.07-4.51), while female respondents reported higher odds of CFT use (OR, 1.89; 95% CI, 1.01-3.54).
Conclusions: Significant global disparities exist in the diagnostic evaluation of MINOCA. After adjustment, economic context emerged as the most consistent determinant of advanced diagnostic modality use. These findings highlight persistent structural barriers to the implementation of guideline-recommended MINOCA evaluation and underscore the need for strategies that expand access to advanced diagnostics and promote standardized evaluation pathways across diverse health care settings.
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BibTeX
@article{dakhil2026global,
title = {{Global Disparities in Diagnostic and Therapeutic Strategies for Myocardial Infarction With Non-obstructive Coronary Arteries: An International Survey}},
author = {Zainab Atiyah Dakhil and Hasan Ali Farhan and Julia Grapsa and Mirvat Alasnag},
journal = {Journal of the Society for Cardiovascular Angiography \& Interventions},
year = {2026},
month = aug,
doi = {10.1016/j.jscai.2026.105560},
url = {https://doi.org/10.1016/j.jscai.2026.105560},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Global Disparities in Diagnostic and Therapeutic Strategies for Myocardial Infarction With Non-obstructive Coronary Arteries: An International Survey
AU - Zainab Atiyah Dakhil
AU - Hasan Ali Farhan
AU - Julia Grapsa
AU - Mirvat Alasnag
PY - 2026
DA - 2026/08/04
JO - Journal of the Society for Cardiovascular Angiography & Interventions
DO - 10.1016/j.jscai.2026.105560
UR - https://doi.org/10.1016/j.jscai.2026.105560
AB - Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) requires multimodality evaluation, including cardiac magnetic resonance (CMR), intracoronary (IC) imaging, and coronary function testing (CFT). However, real-world uptake of these guideline-recommended modalities varies widely. We conducted a global survey to characterize practice variation in MINOCA evaluation and management across demographic characteristics, continents, and economic settings. Methods: A 16-item online survey targeting cardiologists and cardiology trainees was distributed globally between August and December 2024. Respondents provided information on demographic characteristics, institutional context, and routine diagnostic and therapeutic strategies for MINOCA. Descriptive statistics, χ2 tests, and multiple regression analysis were used to assess associations. Results: A total of 329 cardiology professionals from 6 continents participated (69.6% interventional cardiologists; 45.9% practicing in high-income countries [HIC]). Overall, 64.1% of respondents reported routine statin use and 55.6% reported beta-blocker use in MINOCA management. Advanced diagnostic modalities demonstrated substantial geographic variation. Europe reported the highest use of CMR (80.6%) and CFT (38.9%), whereas IC imaging was most frequently reported in North America (44.1%). Respondents from HIC reported greater routine use of CMR (56.3% vs 31.6%), IC imaging (41.7% vs 28.9%), and CFT (31.1% vs 13.2%) compared with those from lower-income settings (all P < .01). In multivariable analyses, HIC status remained the strongest independent predictor of routine CMR use (odds ratio [OR], 3.95; 95% CI, 2.34-6.68), IC imaging use (OR, 3.01; 95% CI, 1.74-5.20), and CFT use (OR, 2.29; 95% CI, 1.26-4.14). Academic or teaching hospital affiliation was independently associated with higher CMR use (OR, 2.19; 95% CI, 1.07-4.51), while female respondents reported higher odds of CFT use (OR, 1.89; 95% CI, 1.01-3.54). Conclusions: Significant global disparities exist in the diagnostic evaluation of MINOCA. After adjustment, economic context emerged as the most consistent determinant of advanced diagnostic modality use. These findings highlight persistent structural barriers to the implementation of guideline-recommended MINOCA evaluation and underscore the need for strategies that expand access to advanced diagnostics and promote standardized evaluation pathways across diverse health care settings.
SN - 2772-9303
ER -