Cardiac magnetic resonance in patients with acute myocardial infarction: The added clinical value

Cardiovascular magnetic resonance (CMR) has emerged as the reference noninvasive modality for a comprehensive assessment of myocardial injury following acute myocardial infarction (AMI). Beyond accurate quantification of ventricular volumes and ejection fraction, CMR uniquely enables in vivo characterization of the infarct size, the ischemic area at risk, microvascular obstruction, intramyocardial hemorrhage, and interstitial remodeling-pathophysiological processes that are all tightly linked to adverse left ventricular remodeling and long-term clinical outcomes. Advances in late gadolinium enhancement imaging and parametric mapping techniques, including native T1, T2, T2*, and extracellular volume quantification, have now expanded the ability of CMR to capture both irreversible myocardial necrosis and dynamic inflammatory injury within the infarcted and the remote myocardium. Importantly, these imaging biomarkers provide prognostic information incremental to conventional clinical parameters and have become central to risk stratification, etiologic diagnosis in myocardial infarction with non-obstructive coronary arteries (MINOCA), and surrogate endpoint selection in cardioprotective clinical trials. This review provides a contemporary overview of the role of CMR in AMI, with emphasis on optimal timing, pragmatic protocol design, infarct severity phenotyping, post-infarction complications, and risk stratification beyond ejection fraction. Emerging developments, including accelerated imaging, artificial intelligence-assisted analysis, low-field systems, and complementary integration with cardiac computed tomography, are discussed as key drivers shaping the future clinical implementation of CMR in ischemic heart disease.