Seventy-nine consecutive patients (mean age 53 years, 39.2 % male) presenting an ACS with tropinin elevation and normal coronary angiography were prospectively included. All patients underwent CMRI at 3-Tesla within 3 weeks of initial presentation. Adverse events were recorded with a follow-up of 6 months.
An identifiable basis for ACS was established by CMRI in 69.6 % of patients (27.8 % MI, 29.1 % acute myocarditis, 12.7 % TTC). Only troponin level was significantly different between patients with normal vs abnormal CMRI (3.48 ¡À 4.3 vs 11.86 ¡À 11.99 mg/L, respectively, p = 0.0028). During the follow-up, 1 patient in the MI group suffered stroke (1.26 % ). In the myocarditis group, there was 1 episode of congestive heart failure (1.26 % ) and 7 patients had recurrent chest pain without troponin elevation (8.6 % ). Two patients in the TTC group initially presented with cardiogenic shock (2.53 % ), but there were no adverse events in this group during follow-up. In the remaining 30.2 % patients, no clear diagnosis could be identified by CMRI, and no adverse events occurred during follow-up.
CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain diagnosis and to adapt treatment in a large proportion of cases. Nonetheless, patients with no anomalies identified by CMRI have an excellent prognosis, without need for specific treatment.