Cardiac magnetic resonance imaging in patients with acute coronary syndrome and non-obstructive coronary atherosclerosis significantly changed the diagnostic structure, increasing the identification of myocarditis by 20% with a diagnostic accuracy of 78%.
Cohort (n=44)
Open-label
No
Does cardiac magnetic resonance imaging improve the differential diagnosis of acute coronary syndrome in patients with non-obstructive coronary atherosclerosis?
Cardiac MRI with contrast provides high diagnostic accuracy (78%) and significantly alters the clinical diagnosis in patients with MINOCA, particularly by increasing the detection of myocarditis.
Absolute Event Rate: 23% vs 2%
p-value: p=<0.05
Aim. To investigate on the nosological structure of acute coronary syndrome (ACS) in patients with non-obstruction coronary atherosclerosis (NOCA) before and after magnetic resonance imaging (MRI) of the heart. Material and methods . A non-randomized, open, controlled study (NCT02655718). The patients included, with ACS, older than 18 y.o., with NOCA (intact coronary arteries or stenosis ≤50%) confirmed by invasive coronary arteriography (ICAG). Patients with previous revascularization were not included. Results. In the year 2016, to emergency cardiology department (ECD) 913 ACS patients admitted. In 44 (4,8%) the NOCA was found. Mean age 54±10,4 y.o., males 68%, and the groups with ACS with ST elevation (STEACS) and none (NSTEANS) were comparable by clinical and anamnestic parameters. Intact coronary arteries were visualized in 16 (53%), non-significant coronary atherosclerosis was diagnosed in 14 (32%), slower coronary flow — 22 (73%). By MRI with contrast, performed in 11±8 days (2-43 days) from ACS beginning, myocardial oedema was found in 18 (41%), hyperemia in 13 (30%) and fibrosis in 40 (91%); there were no changes in 1 patient. Nosological structure of ACS in NOCA after MRI has been represented: by acute myocardial infarction (MI) in 24 (55%) cases, unstable angina (UA) — in 6 (14%), pseudocoronary myocarditis in 10 (23%), acute aorta dissection in 1 (2%), posttraumatic atherosclerosis in 1 (2%), congenital valve defect in 1 (2%), manifested Wolf-Parkinson-White (WPW) — in 1 (2%). In-hospital mortality was 2%. In comparison of ACS before and post MRI there was significant increase number of patients with myocarditis, by 20%. Conclusion. The prevalence of ACS in NOCA is 4,8%, that is comparable to literature data. Patients with ACS and NOCA are heterogenic group with MI, UA, myocarditis, acute aorta dissection, posttraumatic atherosclerosis, congenital defects, WPW syndrome. In-hospital mortality was 2%. Comparing the structure of the diagnoses before and after MRI, there was significant increase of myocarditis patients number. A high accuracy of MRI was found for differential diagnostics of ACS in NOCA, which was 78%.
Ryabov et al. (2017) conducted a cohort in Acute coronary syndrome with non-obstructive coronary atherosclerosis (n=44). Cardiac magnetic resonance imaging (MRI) with contrast vs. Standard clinical and instrumental evaluation (pre-MRI diagnosis) was evaluated on Diagnosis of myocarditis (p=<0.05). Cardiac magnetic resonance imaging in patients with acute coronary syndrome and non-obstructive coronary atherosclerosis significantly changed the diagnostic structure, increasing the identification of myocarditis by 20% with a diagnostic accuracy of 78%.
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