Coronary disease & ACSDiagnostic or prognostic study
Cardiovascular Magnetic Resonance Before Invasive Coronary Angiography in Suspected Non–ST-Segment Elevation Myocardial Infarction
- Diagnostic accuracy study
- prospective
- consecutive patients
- blinded cardiac magnetic resonance (CMR) interpretation
CMR images interpreted blinded to invasive coronary angiogram (ICA) findings; clinical care and ICA teams blinded to CMR findings until post-ICA
Authors' conclusion
In patients presenting with suspected NSTEMI, a CMR-first strategy identified MI in 67%, nonischemic pathologies in 18%, and normal findings in 11%.
Study context
- Population
- Stable patients with suspected acute NSTEMI (70% male, age 62 ± 11 years)consecutive
- Participants
- 100 patients
- Comparison
- CMR before invasive coronary angiography in suspected NSTEMI
- Outcome
- Diagnostic utility of CMR before ICA (CMR diagnosis)
- Follow-up
- Median 33 hours postadmission and 4 hours pre-ICA
Performance
As reported in the abstract
CMR diagnosis, all patients
- Subendocardial infarction
- 52% (52 of 100)
- Transmural infarction
- 15%
- Nonischemic pathologies (myocarditis, takotsubo, other cardiomyopathies)
- 18%
- Normal CMR
- 11%
- Nondiagnostic
- 4%
Further findings
CMR diagnosis in obstructive CAD on ICA (subgroup, 73 of 100)
- MI
- 84% (61 of 73)
- Nonischemic pathologies
- 10% (7 of 73)
- Normal
- 5% (4 of 73)
CMR diagnosis in nonobstructive coronary arteries (NOCA) (subgroup, 27 of 100)
- MI
- 22% (6 of 27 true MI with NOCA)
- Presumed NSTEMI reclassified
- 67% (18 of 27: 11 nonischemic pathologies, 7 normal)
Different infarct-related artery identified by CMR (CMR-MI and obstructive CAD, 61 of 100)
- Different infarct-related artery
- 11% (7 of 61)
Original publication
Cardiovascular Magnetic Resonance Before Invasive Coronary Angiography in Suspected Non–ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Imaging. Published 4 June 2024. doi:10.1016/j.jcmg.2024.05.007
Summarised from the published abstract; every number is checked against it