Abstract
Acute coronary syndrome (ACS) still remains one of the leading causes of mortality and morbidity worldwide. Seven to fifteen percent of patients presenting with ACS have unobstructed coronary artery disease (CAD) on urgent angiography. Patients with ACS and unobstructed coronary arteries represent a clinical dilemma and their diagnosis and management is quite variable in current practice. Cardiovascular magnetic resonance imaging with its unique non-invasive myocardial tissue characterization property has the potential to identify underlying etiologies and reach a final diagnosis. These include acute and chronic myocarditis, embolic/spontaneous recanalization myocardial infarction, and Tako-Tsubo cardiomyopathy, and other conditions. Establishing a final diagnosis has a direct implication on patient’s management and prognosis. In this article, we have reviewed the current evidence on the diagnostic role of cardiac magnetic resonance (CMR) in patients with ACS and unobstructed coronary arteries. We have also highlighted the potential role of CMR as a risk stratification or prognostication tool for this patient population.
Highlights
Acute coronary syndrome (ACS) still remains one of the leading causes of mortality and morbidity
Emergency or early angiography is recommended in suspected acute coronary syndrome (ACS) with ST-elevation myocardial infarction (STEMI) or in non-ST elevation ACS (NSTE-ACS) with an intermediate-high Global Registry of Acute Coronary Events (GRACE) score
The literature suggests that 7–10 % of patients presenting with STEMI and 10–15 % of patients presenting with NSTEACS have unobstructed coronary artery disease (CAD) on urgent angiography [1,2,3,4,5,6,7,8]
Summary
Acute coronary syndrome (ACS) still remains one of the leading causes of mortality and morbidity. Secondary prevention medications for ACS are used less frequently in these patients than in patients with obstructive CAD [9, 10]. This is partly due to our lack of understanding of the underlying patho-physiological mechanisms leading to the troponin rise and the lack of clear-cut guidelines. A recent systematic review of patients presenting with suspected MI and unobstructed coronary arteries by Pasupathy et al showed an overall allcause mortality of 4.7 % at 12 months [15].
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