Objective To determine the safety and diagnostic accuracy of adenosine-stress cardiac magnetic resonance (CMR) perfusion imaging early after acute ST-elevation myocardial infarction (STEMI) compared to standard exercise tolerance testing (ETT).
Design Cross sectional, observational study.
Setting University teaching hospital.
Patients Thirty-five patients admitted with first acute STEMI.
Interventions All patients underwent a CMR imaging protocol which included rest and adenosine-stress perfusion, viability and cardiac functional assessment. All patients also had an ETT (modified BRUCE protocol) and X-ray coronary angiography.
Main outcome measures Safety and diagnostic accuracy of adenosine-stress perfusion CMR vs. ETT early after STEMI, in terms of identifying patients with significant coronary stenosis (≥70%) and the necessity for coronary revascularisation. Also, to determine if CMR can distinguish between ischaemia in the peri-infarct zone and ischemia in remote myocardium.
Results CMR imaging was well tolerated (all patients completed the protocol) and no complications occurred. CMR was more sensitive (86% vs. 48%, p=0.0074) and more specific than ETT (100% vs. 50%, p<0.0001) to detect significant coronary stenosis and more sensitive to predict revascularisation (94% vs. 56%, p=0.039). Inducible ischemia in the infarct related artery (IRA) territory was seen in 21 of 35 patients and was associated with smaller infarct size and less transmurality of infarction.
Conclusions Adenosine-stress CMR imaging is safe early after acute STEMI and identifies patients with significant coronary stenosis more accurately than ETT.
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