Dual Imaging Identifies Cause of Heart Attacks in Patients Without Blocked Arteries

NYU Langone-led international study supports combining advanced imaging to guide diagnosis and care for a condition more common in women.

Mar. 28, 2026 at 6:23pm

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A new study led by researchers at NYU Langone Health shows that using a combination of coronary optical coherence tomography (OCT) and cardiac magnetic resonance imaging (MRI) can identify the underlying cause of heart attacks in most patients without significant coronary artery narrowing, a condition known as MINOCA. The findings, presented at the American College of Cardiology's 2026 Annual Scientific Session, provide important support for current clinical guidelines and highlight the limitations of standard angiography in these complex cases.

Why it matters

MINOCA accounts for 6 to 15 percent of heart attacks and is about three times more common in women than men. Understanding the underlying cause is critical for guiding appropriate treatment, as MINOCA can be caused by a variety of conditions that require different approaches compared to traditional heart attacks.

The details

Researchers enrolled 336 patients across 28 international sites and found that using both OCT and cardiac MRI together identified a likely cause in 79 percent of cases. Most (59 percent) had a typical heart attack mechanism related to reduced blood flow, while 20 percent had conditions that mimic a heart attack, such as myocarditis or takotsubo syndrome. The study found no significant differences in underlying causes between women and men once MINOCA developed.

  • The study findings were presented at the American College of Cardiology's 2026 Annual Scientific Session.
  • The results were simultaneously published on March 28, 2026 in the journal Circulation.

The players

Harmony R. Reynolds, MD

Lead author of the study and director of the Cardiovascular Clinical Research Center in the Leon H. Charney Division of Cardiology at NYU Langone Health.

NYU Langone Health

A fully integrated health system that consistently achieves some of the lowest mortality rates in the nation and is ranked No. 1 in the country for cardiology, heart, and vascular surgery by U.S. News & World Report.

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What they’re saying

“When arteries are not badly blocked, it can be unclear what caused the event. What we show is that in most cases, we can find the underlying explanation, and most often it is a true heart attack. Our results support the need to do specialized imaging in all patients with MINOCA, because we could not reliably predict who will have specific imaging findings.”

— Harmony R. Reynolds, MD, Lead author and director of the Cardiovascular Clinical Research Center

“This is a scary type of heart attack. When you don't know what caused it, you worry anything could trigger it again.”

— Ashley Perlow

What’s next

Future research will focus on developing treatment strategies tailored to the specific causes identified through imaging.

The takeaway

This study highlights the importance of using advanced diagnostic imaging techniques like OCT and cardiac MRI to identify the underlying causes of heart attacks in patients without significant coronary artery blockages, which is critical for guiding appropriate treatment and improving outcomes, especially for women who are disproportionately affected by this condition.