A narrative review of electrocardiogram manifestation of myocardial infarction with non-obstructive coronary arteries (MINOCA)
Bibliographic record
Abstract
Background and Objective: Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a unique subset of acute coronary syndromes where significant coronary artery obstruction is absent. Despite its clinical relevance, the role of electrocardiogram (ECG) in the diagnosis of MINOCA remains underexplored, with no specific guidelines established. This review examines the current literature to elucidate potential diagnostic markers and guide clinical management. Methods: A non-systematic review was conducted using the PubMed database, focusing on literature from 2015 onwards, involving studies that analyze the ECGs of patients with MINOCA. Additional data from two representative MINOCA cases at Kingston Health Sciences Centre were also reviewed to illustrate real-world ECG variability and diagnostic value. Key Content and Findings: ST-segment elevations are observed in 5-10.5% of MINOCA cases and studies performed on women found ST-segment depression in 15% of cases, T-wave inversions in 45% of cases, prolonged QTc intervals in 28% of cases and 35% present with a normal initial ECG. Conclusions: Recognizing these diverse ECG presentations of MINOCA is crucial for tailoring management strategies to the underlying pathology, thereby minimizing both over-treatment and under-treatment. Future studies should prioritize longitudinal tracking of ECG changes and correlations with outcomes to establish standardized diagnostic criteria and improve prognostic stratification. This review highlights the significance of conducting additional research to develop clear ECG guidelines tailored specifically for MINOCA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".