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Original article
Imaging diagnoses and outcome in patients presenting for primary angioplasty but no obstructive coronary artery disease
  1. Tarun K Mittal1,
  2. Luise Reichmuth2,
  3. Ben Ariff3,
  4. Praveen P G Rao4,
  5. Aigul Baltabaeva1,
  6. Shelley Rahman-Haley1,
  7. Tito Kabir1,
  8. Joyce Wong1,
  9. Miles Dalby1
  1. 1Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
  2. 2Department of Imaging, Mater Dei University Hospital, Malta, Malta
  3. 3Department of Imaging, Imperial College NHS Healthcare Trust, London, UK
  4. 4Department of Imaging, Glenfield Hospital, University Hospital of Leicester, Leicester, UK
  1. Correspondence to Dr Tarun K Mittal, Department of Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Hill End Road, Middlesex, London UB9 6JH, UK; t.mittal{at}


Objective A proportion of patients with suspected ST-elevation myocardial infarction (STEMI) presenting for primary percutaneous coronary intervention (PPCI) do not have obstructive coronary disease and other conditions may be responsible for their symptoms and ECG changes. In this study, we set out to determine the prevalence and aetiology of alternative diagnoses in a large PPCI cohort as determined with multimodality imaging and their outcome.

Methods From 2009 to 2012, 5238 patients with suspected STEMI were referred for consideration of PPCI. Patients who underwent angiography but had no culprit artery for revascularisation and no previous history of coronary artery disease were included in the study. Troponin values, imaging findings and all-cause mortality were obtained from hospital and national databases.

Results A total of 575 (13.0%) patients with a mean age of 58±15 years (69% men) fulfilled the inclusion criteria. A specific diagnosis based on imaging was made in 237 patients (41.2%) including cardiomyopathies (n=104, 18%), myopericarditis (n=48, 8.4%), myocardial infarction/other coronary abnormality (n=27, 4.9%) and severe valve disease (n=23, 4%). Pulmonary embolism and type A aortic dissection were identified in seven (1.2%) and four (0.7%) cases respectively. A total of 40 (7.0%) patients died over a mean follow-up of 42.6 months.

Conclusions A variety of cardiac and non-cardiac conditions are prevalent in patients presenting with suspected STEMI but culprit-free angiogram, some of which may have adverse outcomes. Further imaging of such patients could thus be useful to help in appropriate management and follow-up.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors TKM initiated and proposed the study. PPGR and LR collected the data. TKM, AG, SR-H and JW checked the data for their respective imaging modalities. TKM and LR performed the statistical analysis and initial draft of the manuscript. BA, TKM, LR, AG, SR-H, TK, JW and MD revised the manuscript. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Ethics approval Royal Brompton & Harefield NHS Foundation Trust.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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