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In suspected non-ST-segment-elevation myocardial infarction (NSTEMI), this presumed diagnosis may not hold true in all cases, particularly in patients with non-obstructive coronary arteries (NOCA). Additionally, in multi-vessel coronary artery disease (MVD), the presumed infarct-related artery (IRA) may be incorrect. To assess the diagnostic utility of cardiovascular magnetic resonance (CMR) before invasive coronary angiogram (ICA) in suspected NSTEMI. 100 consecutive stable patients with suspected acute NSTEMI (70% male, age 62±11 years) prospectively underwent CMR pre-ICA to assess cardiac function (cine), edema (T2-weighted imaging, T1-mapping) and necrosis/scar (late gadolinium enhancement). CMR images were interpreted blinded to ICA findings. The clinical care and ICA teams were blinded to CMR findings until post-ICA. Early CMR (median 33 hours post-admission and 4 hours pre-ICA) confirmed only 52% (52/100) subendocardial infarction, 15% transmural infarction, 18% non-ischemic pathologies (myocarditis, Takotsubo, cardiomyopathies) and 11% normal CMR. 4% were non-diagnostic. Sub-analyses according to ICA findings showed that, in patients with obstructive CAD (73/100), CMR confirmed only 84% (61/73) MI, 10% (7/73) non-ischemic pathologies and 5% (4/73) normal. In patients with NOCA (27/100), CMR found MI in only 22% (6/27 true MINOCA) and reclassified the presumed diagnosis of NSTEMI in 67% (18/27: 11 non-ischemic pathologies, 7 normal). In patients with CMR-MI and obstructive CAD (61/100), CMR identified a different IRA in 11% (7/61). In patients presenting with suspected NSTEMI, a CMR-first strategy identified MI in 67%, non-ischaemic pathologies in 18% and normal findings in 11%. has Accordingly, CMR has the potential to impact at least 50% of all patients by reclassifying their diagnosis or altering their potential management.
Shanmuganathan et al. (Wed,) studied this question.