SPC365

Cardiac Magnetic Resonance Access and Clinical Relevance in MINOCA: Insights from a Tertiary Center Experience

Session: Sessão de Posters 32 - MINOCA
Speaker: Mariana Isabel Duarte Almeida

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.7 Acute Coronary Syndromes - Other
Session Type: Cartazes
FP Number: ---
Authors: Mariana Duarte Almeida; João Gouveia Fiuza; Gonçalo Ferreira; Vanda Devesa Neto; Luísa Gonçalves; Nuno Craveiro
<p style="text-align:justify"><strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">Background:</span></strong><span style="color:#000000; font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif; font-size:medium"> Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is characterized by clinical manifestations of myocardial infarction symptoms, substantial troponin elevation, and no significant coronary artery obstruction (</span><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">greather than or equal to 50%). It is considered a working diagnosis until further assessment clarifies the troponin elevation cause. Despite not being universally accessible, Cardiac Magnetic Resonance (CMR) is strongly recommended per European and American clinical guidelines, ideally within 2 weeks of event, to refine diagnosis and improve therapeutic strategies. The aim of this study was to access CMR&rsquo;s clinical utility in MINOCA-diagnosed patients during their hospitalization. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif"><span style="color:black">Methods:</span></span></strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif"><span style="color:black"> Retrospective data from June 2021 to May 2023 were collected for chest pain admissions in Cardiac Intensive Care Unit with elevated troponin levels suggestive of myocardial infarction,&nbsp;and absence of significant coronary artery obstruction. Demographics, troponin levels, CMR details,&nbsp;changes in diagnosis and management, and outcomes were gathered</span></span><span style="font-size:11pt"><span style="font-family:TimesNewRomanPSMT,serif"><span style="color:black">.</span></span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="color:#000000"><strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">Results:</span></strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif"> A cohort of 58 patients, 67.2% being females, was analyzed. The mean age was 65.8 </span></span><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-family:Symbol"><span style="color:black">&plusmn;&nbsp;</span></span></span></span><span style="color:#000000"><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">15.9 years old. The average hospital stay was 7.6 </span></span><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-family:Symbol"><span style="color:black">&plusmn;&nbsp;</span></span></span></span><span style="color:#000000"><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">4.6 days. The median maximum troponin level was 3957.5 ng/L (interquartile range: 7555.8 ng/dL). Of these patients, 22.4% underwent in-hospital CMR, while 34.5% underwent outpatient CMR, resulting in a cumulative utilization rate of 56.9% (n=33). The median time to CMR was 14 days (interquartile range: 36.5 days), with in-hospital CMR having a shorter duration (median: 8.0 days, interquartile range: 4.0 days) compared to outpatient CMR (median: 38.5 days, interquartile range: 45.1 days).</span><span style="font-family:Calibri,sans-serif">&nbsp;This difference was statistically significant (U=20.000, p&lt;0.001).&nbsp;</span></span><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">CMR was performed within two weeks post-event in 51.5% of cases. The results lead to diagnostic and therapeutic strategies changes for 48.5% and 57.6% of patients, respectively. Undergoing CMR scan was significantly associated with a reduced likelihood of readmission due to cardiovascular causes (</span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">&chi;</span><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">&sup2;=4.664, p=0.031) and a lower 6-month mortality rate (</span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">&chi;</span><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">&sup2;=5.671, p=0.017).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">Conclusions:</span></strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif"> The undeniable clinical value of CMR, as evidenced by substantial alterations in patient management, highlights potential suboptimal care for those not undergoing CMR. The reliance on external resources in our hospital underscores the imperative need to establish infrastructure conducive to increased CMR utilization, encompassing requisite equipment and adequately trained personnel.</span></span></span></span></p>