Abstract Funding Acknowledgements Type of funding sources: None. Introduction The differential diagnosis in patients with chest pain, a dynamic troponin rise and unobstructed coronary arteries is broad. Cardiac magnetic resonance (CMR) imaging can differentiate between the aetiologies of myocardial injury The UK has a low number of MR scanners/million people compared to Germany (8.6 v 34.4) resulting in poor equity in access to CMR (1). Our hospital relies on an off-site private health care provider for the CMR service. Background The 2020 ESC Taskforce guidelines recommend the use CMR in all myocardial infarction with normal coronary artery (MINOCA ) patients ideally within 2 weeks. Purpose There were three objectives: 1. To identify what proportion of these patients had a CMR scan 2. To determine the mean CMR waiting time 3. To establish in how many cases CMR changed the diagnosis and patient management. Methods We retrospectively collected the data from January - December 2021 of all patients admitted to our hospital with chest pain, a dynamic troponin rise and unobstructed coronary arteries on coronary angiography. Patient demographics, troponin levels, the discharge diagnosis, timing and details of CMR study and changes in diagnosis and management post CMR scan were recorded. Results 81 patients fit inclusion criteria (49% male, mean 61.2±14.8 years). Mean troponin rise 271±403 ng/L. 45% underwent CMR imaging. Mean waiting time for CMR 35 ± 26.9 days. 21% had CMR in < 14 days. CMR scan led to a change in diagnosis in 40% and changed management in 29.7%. In 37.5 % of patients with a pre-scan diagnosis of myocarditis were found to have myocardial infarction post CMR scan. Conclusion The majority (55%) of our MINOCA patients did not have CMR imaging and the minority had it in < 2 weeks. As CMR led to a management change in almost one third of patients there is no doubt that our patients are getting suboptimal care due to lack of timely access to CMR. This study shows the difficulties of implementing guidelines in the real world particularly in a UK hospital where resources are strained and rapid expansion of urgent CMR slots is not possible.
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