Acute Coronary Syndrome, Non-ST Elevation Myocardial Infarction
Conditions
Keywords
CMR, MRI, Cardiac MRI, Cardiac Magnetic Resonance, Cardiac Magnetic Resonance imaging, AMI, ACS, Acute Coronary Syndrome, NSTEMI, Non-STEMI, ICA, Invasive Coronary Angiography, Coronary Angiography, T1, T2, Magnetic Resonance Fingerprinting, Native T1, Native T2, Magnetic Resonance Angiography
Brief summary
Patients with a suspected myocardial infarction are subdivided into ST-elevation and non-ST-elevation myocardial infarctions (STEMI and NSTEMI, respectively) using ECG. While patients with STEMI are urgently referred to a cath lab, patients with NSTEMI usually undergo a planned invasive coronary angiography (ICA) anywhere from 24-72 hours after arriving to the hospital. When an invasive coronary angiography can not explain the cause of a myocardial infarction, an MRI of the heart (a CMR) is often done as a follow-up investigation. A growing body of evidence suggests that performing a CMR before the planned ICA can provide an accurate diagnosis and defer the need for an ICA in many of these patients with NSTEMI.
Detailed description
KaPSICA-CMR is an observational pilot study at the Karolinska University Hospital which aims to validate, in a Swedish healthcare setting, the potentials of a CMR-first approach in patients with suspected NSTEMI. We plan to include 150 patients, both with (n=50) and without (n=100) previous myocardial infarction. In addition to a standard clinical CMR protocol, the study will test novel CMR techniques such as magnetic resonance angiography and magnetic resonance fingerprinting sequences in this cohort. Patients will be recruited at both the Solna- and Huddinge sites of the hospital and include patients referred to ICA from the Visby- and Södertälje hospitals. The findings on the CMR will be blinded to treating physicians, with exceptions for unexpected adverse findings. In the event that a CMR would be indicated in line with clinical practice, the CMR findings are unblinded.
Interventions
DIAGNOSTIC_TESTCardiac MRI (CMR) examination
An MRI examination of the heart (CMR) is presently performed as a follow-up examination in patients where an invasive coronary angiography (ICA) shows no obstructive findings. The intervention in this study is characterized by having the CMR performed before, rather than after, the ICA. In addition, this study will implement some novel CMR sequences which have not been previously tested in this patient cohort: * CMR Angiography (imaging the coronary arteries using MRI) * CMR Fingerprinting (sequences which perform T1 and T2 mapping simultaneously)
Sponsors
Region Stockholm
The Swedish Research Council
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ≥18 years of age Suspected NSTEMI (signs and symptoms suggest of ACS with initial ECG showing no ST-elevation) * Planned ICA where CMR can be performed without delaying ICA * Able to provide written informed consent
Exclusion criteria
* Contraindications for CMR examination with gadolinium contrast (claustrophobia, eGFR \<30ml/min/1.73m2, contrast allergy, and non-MRI compatible implants) * Arrythmias which hinder CMR examination * Previous CABG * Hemodynamic instability * Myocardial infarction \<6 months prior to inclusion
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of non-ischemic diagnosis | Every three months, until study completion | In cases where CMR establishes a diagnosis which is non-ischemic in nature, such as a myocarditis, an ICA can be deferred since a diagnosis has been made using CMR. |
| Rate of IRA territory reclassification | Every three months, until study completion | One primary outcome measurement will be to what extent a CMR examination can reclassify the IRA (infarct-related artery) territory established on ICA, by designating a new IRA based on the area of infarction on CMR using the 17-segment model of the American Heart Association and magnetic resonance angiography |
Countries
Sweden
Contacts
CONTACTDaniel F Andersson, M.D.
PRINCIPAL_INVESTIGATORMarcus E Carlsson, Professor
Karolinska Insitutet and Karolinska University Hospital
Outcome results
None listed