13 Prognosis after myocardial infarction with non-obstructive coronary arteries according to receipt of cardiovascular magnetic resonance imaging

Introduction Cardiovascular magnetic resonance imaging (CMR) is guideline recommended for patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) to establish the underlying aetiology.1 However, the impact on patients' management and long-term cardiovascular outcomes is unclear. Materials and Methods Patients undergoing invasive coronary angiography for suspected coronary artery disease were prospectively recorded in the hospital electronic database (CATHi). The study period was pre-defined as 1ST October 2009 to 1st October 2019. Eligible patients in the CMR group had MINOCA defined by the universal acute myocardial infarction (AMI) criteria, normal coronary arteries (≤50% stenosis), no other cause for the clinical presentation at angiography and underwent CMR. Follow up was conducted by review of electronic clinical records (Orion Health Clinical Portal). Aims Primary outcome was a change in diagnosis following CMR. Secondary outcomes included death and major adverse cardiovascular events (MACE: stroke/TIA, worsening heart failure, cardiac re-admission and cardiac intervention) between the CMR group and controls. Results Out of 1,183 patients diagnosed with MINOCA, 227 (18.9%, 53 ± 13 years; 114 females, 50.2%) underwent CMR as part of their care plan. Eighty-five patients (37.4%) had a change in diagnosis following CMR. A final classification by CMR was provided in 217 patients (95.6%) and 42 patients had a normal CMR. A change in treatment resulted in 35/85 MINOCA patients (41.2%) that had a change in their diagnosis. Patients with change in diagnosis and treatment had fewer MACE (OR=0.672, 95%CI 0.569,0.795, pDiscussion Risk stratification of patients based on their CMR diagnosis can help clinicians to predict patient prognosis and provide tailored medical therapy to specific endotypes of presentations with MINOCA to improve patient cardiovascular outcomes. Conclusion CMR imaging was performed in 18.9% of patients with MINOCA and the diagnosis changed in one third of these patients. Change in treatment in those who received CMR was associated with improved cardiovascular outcomes. Acknowledgements This study was supported by the University of Glasgow. Reference Byrne RA. et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur. Heart J. ehad191 (2023) doi:10.1093/eurheartj/ehad191.