Cardiac magnetic resonance reclassified the diagnosis in 78% of patients presenting with suspected MINOCA, confirming MINOCA in only 27% while identifying alternative diagnoses in 73%.
Cohort (n=888)
No
Does CMR reclassify the diagnosis in patients with suspected MINOCA?
CMR is highly effective in reclassifying the diagnosis of patients with suspected MINOCA, identifying alternative non-ischemic causes in nearly three-quarters of cases.
AIMS: In ∼5-15% of all cases of acute coronary syndromes (ACS) have unobstructed coronaries on angiography. Cardiac magnetic resonance (CMR) has proven useful to identify in most patients the underlying diagnosis associated with this presentation. However, the role of CMR to reclassify patients from the initial suspected condition has not been clarified. The aim of this study was to assess the proportion of patients with suspected MINOCA, or non-MINOCA, that CMR reclassifies with an alternative diagnosis from the original clinical suspicion. METHODS AND RESULTS: A retrospective cohort of patients in a tertiary cardiology centre was identified from a registry database. Patients who were referred for CMR for investigation of suspected MINOCA, and a diagnosis pre- and post-CMR was recorded to determine the proportion of diagnoses reclassified. A total of 888 patients were identified in the registry. CMR reclassified diagnosis in 78% of patients. Diagnosis of MINOCA was confirmed in only 243 patients (27%), whilst most patients had an alternative diagnosis (73%): myocarditis n = 217 (24%), Takotsubo syndrome n = 115 (13%), cardiomyopathies n = 97 (11%), and normal CMR/non-specific n = 216 (24%). CONCLUSION: In a large single-centre cohort of patients presenting with ACS and unobstructed coronary arteries, most patients had a non-MINOCA diagnosis (73%) (myocarditis, Takotsubo, cardiomyopathies, or normal CMR/non-specific findings), whilst only a minority had confirmed MINOCA (27%). Performing CMR led to reclassifying patients' diagnosis in 78% of cases, thus confirming its important clinical role and underscoring the clinical challenge in diagnosing MINOCA and non MINOCA conditions.
Liang et al. (Tue,) conducted a cohort in Suspected MINOCA or non-MINOCA (n=888). Cardiac magnetic resonance (CMR) vs. Initial clinical suspicion was evaluated on Proportion of diagnoses reclassified by CMR. Cardiac magnetic resonance reclassified the diagnosis in 78% of patients presenting with suspected MINOCA, confirming MINOCA in only 27% while identifying alternative diagnoses in 73%.