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Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) accounts for 10%–15% of acute MI presentations and is an umbrella term reflecting a heterogeneous group of causal endotypes including cardiac (coronary and non-coronary endotypes) and systemic causes. Around one in four patients with MINOCA lack an established cause. If the final diagnosis is not established (or is incorrect) then medical management may fail to prevent repeated episodes of unplanned care. The 2023 Acute Coronary Syndrome Guidelines of the European Society of Cardiology (ESC) recommend to follow a diagnostic algorithm for patients with a working diagnosis of MINOCA 1 yet implementation of these guidelines in daily practice may be inconsistent, with underuse of advanced invasive and non-invasive imaging, and inconsistent postdischarge evaluation.