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Introduction: MINOCA (Myocardial Infarction in non-obstructive coronary artery disease) is a recently described infarct subtype. There are few data that examine CAD (Coronary artery disease), extent MI size and type, and treatment differences at hospital discharge compared to MIOCA (Myocardial Infarction in obstructive coronary artery disease), or sex-specific MINOCA attributes of coronary anatomy and infarct size. Hypothesis: CAD extent, MI size and type, and guideline recommended treatment at hospital discharge are similar in MINOCA and MIOCA pts. Clinical characteristics of MINOCA pts are similar in men and women. Method: Single tertiary-center cohort study of consecutive pts that had coronary angiography for acute MI between 2005 and 2015. MI type at presentation (STEMI vs NSTEMI), MI size (peak cardiac troponin value (cTn) and ejection fraction (EF)) and gender differences in the MINOCA pts were examined. MINOCA was defined by absence of obstructive CAD >50% (n=87) and MIOCA by presence of stenosis ≥50% (n=1611) Result: Among 1,698 cases with acute MI, 87 had MINOCA (5.1%). MINOCA pts were younger, more often had NSTEMI, lower peak cTn values, and greater EF than MIOCA pts. Interestingly, frequency of multi-vessel disease involvement was similar in both groups. At hospital discharge, MINOCA pts less frequently received beta blockers or angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) therapy; 30-day re-admission rates were similar (Table). Women with MINOCA (n=41) had smaller MI's (peak cTn 14 vs 72 ng/ml; p<0.001), higher EF (53% vs 46.5% p=0.002) than the women with MIOCA (n=358) and were significantly less likely to be diabetic, hypertensive or hyperlipidemic. When the 87 MINOCA pts were examined, sex comparisons revealed women were older than men (60 vs 52 yrs., p<0.001), had lower mean peak cTn values (14.2 vs 29 ng/ml, p<0.001), greater EF (56% vs 48%, p=0.02) and more single vessel disease than men (73.2% vs 10.6%, p<0.0001). Conclusion: On average, MI size is smaller in MINOCA than MIOCA pts, and there are sex-related differences in clinical presentation, CAD extent and MI size. Re-admission rates are similar but MINOCA pts are less likely to receive guideline recommended medical therapy at discharge. [ABSTRACT FROM AUTHOR]