Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a complex and diverse disease with great heterogeneity in pathophysiologic mechanisms and treatment prognosis. It is difficult to fully clarify the mechanism by conventional examination. Optical coherence tomography (OCT) visualizes the microstructure of vascular plaques with high resolution and identifies vulnerable plaques more accurately. The aim of this review is to use this technique to delve into the morphological features of MINOCA for a more comprehensive understanding of disease progression. Accurate characterization of plaques and identification of vulnerable plaques can help develop individualized treatment plans, improve prognosis, and reduce mortality.