ST-segment elevation and cardiac magnetic resonance imaging findings in myocardial infarction with non-obstructive...

Area of Science:

• Cardiology
• Diagnostic Imaging
• Clinical Research

Background:

• Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinical diagnosis with varied underlying causes.
• ST-elevation (STE) on presenting electrocardiograms (ECGs) in MINOCA patients has been linked to adverse outcomes.
• Cardiac magnetic resonance imaging (CMR) is valuable for differentiating ischemic from non-ischemic etiologies in MINOCA.

Purpose of the Study:

• To investigate the association between ST-elevation (STE) on presenting electrocardiograms (ECGs) and cardiac magnetic resonance imaging (CMR) findings in patients diagnosed with MINOCA.
• To determine if CMR can explain the increased risk observed in MINOCA patients with STE.

Main Methods:

• Pooled data from three prospective cohort studies involving patients with a provisional diagnosis of MINOCA who underwent CMR.
• ST-elevation (STE) was defined as ≥1 mm in ≥2 contiguous leads on the ECG.
• CMR findings analyzed included evidence of infarction, myocarditis, and left ventricular wall motion patterns consistent with takotsubo syndrome.

Main Results:

• Among 292 MINOCA patients (57 with STE, 231 without), no significant difference was found in CMR findings for infarction (21% vs. 18%), myocarditis (10% vs. 14%), or takotsubo syndrome (16% vs. 14%) between groups.
• The presence or absence of STE on the ECG did not correlate with the likelihood of these specific CMR findings.

Conclusions:

• ST-elevation (STE) on the presenting ECG is not associated with cardiac magnetic resonance imaging (CMR) findings in patients with a provisional MINOCA diagnosis.
• The elevated risk associated with STE in MINOCA patients does not appear to be explained by differences in CMR-detectable infarction, myocarditis, or takotsubo patterns.