Non-ST-segment-elevated myocardial infarction (NSTEMI) patients often present with multivessel or non-significant coronary artery disease. This can complicate identification of the infarct-related artery (IRA), increasing the likelihood of revascularization of non-culprit arteries.
A recently published study by Heitner et al. has investigated the potential use of delayed-enhancement cardiac magnetic resonance (DE-CMR) in identifying the IRA following NSTEMI, comparing the outcome to traditional coronary angiography. The prospective study enrolled 114 patients, all presenting with their first myocardial infarction, across three centres in the United States. All patients underwent DE-CMR followed by coronary angiography, and images were independently reviewed to determine whether, when compared with coronary angiography, DE-CMR could 1) lead to a new IRA diagnosis or 2) elucidate a non-coronary arterial disease (CAD) pathogenesis for the myocardial necrosis.
The data indicate that in 42 of these 114 patients (37 %), it was not possible to clearly identify the IRA using coronary angiography alone. However, upon review of the DE-CMR images, the culprit artery was identified in 25 of these ‘non-IRA identifiable’ patients, with a non-CAD diagnosis being made in 8 patients. Where it was possible to determine the IRA using coronary angiography (72 of the 114 patients, 63 %), DE-CMR elucidated a different IRA in 10 patients and a non-CAD diagnosis in 9 patients.
This suggests that in patients who have experienced NSTEMI, DE-CMR could lead to a new IRA or non-CAD diagnosis in almost half of all NSTEMI patients, which in turn may reduce the likelihood of revascularization of non-culprit arteries in this patient population.
Author: Daniel Guns, Cardiology Update
Original article: Circ Cardiovasc Interv. 2019;12:e007305.