Canadian Cardiovascular Society

Myocardial Infarction with No Obstructive Coronary Artery Disease (MINOCA) can be an invisible diagnosis to many clinicians. And by being invisible, it is often untreated. MINOCA represents 6%-15% of all acute coronary syndromes, with women disproportionately represented and likely undiagnosed.   

A persistent gap in clinical outcomes is observed in women diagnosed with myocardial infarction (MI), including:   

  • increased risk of in-hospital death;  
  • recurrent MI;   
  • long-term mortality with proportionately higher mortality rates after MI, particularly in younger women in Canada who are also more likely to be diagnosed with MINOCA.   

A new Canadian Cardiovascular Society (CCS)/Canadian Women’s Heart Health Alliance (CWHHA) Clinical Practice Update on MINOCA provides readers with up-to-date guidance on 5 key areas:   

  • what MINOCA is and how not to miss it;  
  • the importance of excluding diagnostic “mimickers”;    
  • flexible diagnostic pathways that are focused on laboratory testing, as well as non-invasive and invasive imaging that can be adapted on the basis of each institution’s availability and expertise;   
  • the importance of understanding the underlying pathophysiology causing the MINOCA event to optimize treatment;    
  • the added benefit of post-acute care resources, including referral to cardiac rehabilitation and centres of excellence.   

“With the launch of the CCS MINOCA Clinical Practice Update, developed in partnership with the Canadian Women’s Heart Health Alliance, we’re taking a significant stride towards advancing care for patients with MINOCA. This initiative underscores our shared commitment to enhancing clinical understanding and optimizing management strategies, ensuring better outcomes for individuals navigating this complex condition. Together, we’re forging pathways toward more effective and personalized care for men and women with MINOCA.” – Thais Coutinho, MD and Christine Pacheco, MD, MSc, FRCPC, co-chairs of the MINOCA CPU.  

About the Canadian Cardiovascular Society: 
The CCS is the national voice for cardiovascular clinicians and scientists, representing more than 2,500 cardiologists, cardiac surgeons, and other heart health specialists across Canada. We advance heart health for all by setting standards for excellence in heart health and care, building the knowledge and expertise of the heart team, and influencing policy and advocating for the heart health of all Canadians. For further information on the CCS visit:

About the Canadian Women’s Heart Health Alliance: 
The CWHHA’s vision is to improve women’s cardiovascular health across their lifespan by supporting clinicians, scientists, patients, and decision-makers to implement evidence, transform clinical practices and impact public policy related to women’s cardiovascular health. The CWHHA consists of nearly 200 member clinicians, scientists, allied health professionals, program administrators, and patient partners from across Canada and is powered by the Canadian Women’s Heart Health Centre at the University of Ottawa Heart Institute, with funding support from the University of Ottawa Heart Institute Foundation. For more information, visit:


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