Myocardial Infarction with Normal Coronary Arteries: A Role for MRI?

We recently cared for several patients with chest discomfort characteristic of coronary disease, electrocardiogram (ECG) changes, and increasing troponin concentrations. Coronary angiography revealed mild or no coronary artery disease (CAD), so we evaluated these patients with contrast-enhanced cardiac MRI. Our data suggest that these patients had myocardial infarction (MI). With Institutional Review Board permission, we reviewed our angiography database for patients with normal coronary arteries or mild coronary artery disease during the period from January 2005 to November 1, 2006, to augment those cases we found clinically. Inclusion criteria included presentation with acute coronary syndrome, increased serum troponin T concentration (>0.01 μg/L), or mild or absent CAD by angiography and a contrast-enhanced cardiac MRI (CE-CMR) considered diagnostic for infarction. Patients with prior infarction, known CAD, heart failure, pulmonary embolism, or suspected pericarditis/myocarditis were excluded. Eight patients met these criteria. All angiogram results were reviewed by one of the investigators (V.M.). CE-CMR studies performed on a GE Signa CVi system …