A narrative review of electrocardiogram manifestation of myocardial infarction with non-obstructive coronary arteries (MINOCA).

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.