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About 90% of patients with clinical presentation of acute myocardial infarction (AMI) undergoing coronary angiography have obstructive coronary artery disease (CAD) (i.e. ≥50% stenosis). These patients have well-established therapeutic management.1,2 However, 10% of patients with AMI have no-significant epicardial CAD on coronary angiography, that includes both patients with normal coronary arteries and patients with mild coronary atheromatosis (stenosis < 50%). The aetiology of the myocardial necrosis is not immediately apparent, and there are few data about therapeutic strategies.3,4 Importantly, identifying the pathophysiological mechanism of myocardial infarction with no obstructive coronary arteries (MINOCA) is key for prognostic assessment and therapeutic approach.5–7

Recurrent chest pain: ‘what is essential is invisible to the eye?’