Impact of local CMR service on MINOCA management - a DGH experience

Abstract Introduction Cardiac MRI (CMR) helps to determine the underlying aetiology of those presenting with a working diagnosis of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) and guides further management and risk factors modification1. CMR performed within 14 days has the highest yield and current guidelines also advocate early CMR2. Local CMR service was established in our DGH in November 2022. We reviewed the effectiveness of in-house CMR service, and the reclassification of patients into ischaemic and non-ischaemic categories based on CMR findings. Methods Suspected MINOCA patients were identified from the Myocardial Infarction National Audit Project (MINAP) registry and local CMR database, by doing case review of every patient who presented with troponin positive chest pain at our centre and subsequently underwent invasive coronary angiography showing non-obstructive coronaries. The number of CMR studies, and proportion of studies performed within 2 weeks of presentation for patients with probable MINOCA before and after establishment of local CMR service [April 2019 to April 2021 (Group 1) vs. Nov 2022 to Oct 2024 (Group 2)] was compared. For group 2, we also looked at how CMR reclassified patients into ischemic and non-ischemic causes of troponin positive chest pain presentation and reviewed the rates of re-presentation with chest pain to emergency department. Results CMR was performed in only 13 patients from Group 1 vs 124 in Group 2. No scans (0/13, 0%) were completed within 2 weeks of referral with out of area CMR service (group 1) versus 107/124 (86%) of studies were undertaken within 2 weeks of request in group 2 patients (p