CMR in MINOCA V1.0
Research type
Research Study
Full title
The Incremental value of cardiac magnetic resonance (CMR) imaging for clinical decision-making in myocardial infarction with non-obstructive coronary arteries (MINOCA)
IRAS ID
255358
Contact name
David Austin
Contact email
Sponsor organisation
The James Cook University Hospital
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
A heart attack typically occurs due to abrupt coronary obstruction by thrombus within an inflamed fatty plaque. However, in 5%-10% of cases, the coronary arteries appear unobstructed on angiography. Often, an alternative condition has simply masqueraded as as heart attack, but in 20-40% of cases the aetiology was dynamic thrombus due to plaque rupture that is no longer evident at angiography. Diagnosis and management are therefore often very unclear in this presentation. Current consensus statements recommend standard heart attack therapy (including 2 blood thinners for 12 months) to avert the risk of recurrence in those 20-40% of cases where thrombus was the cause, but it follows that 60-80% of patients will then be inappropriately exposed to the attendant bleeding risks of this medication.
Cardiac MRI (CMR) has emerged as a highly informative imaging tool in this setting, providing a 'virtual biopsy' that can clarify the diagnosis. However, quite often even CMR fails to demonstrate a cause, and it is also true that the physician's "best guess" may actually be pretty accurate. There are currently no prospective data describing how often CMR truly informs and / or changes diagnosis and management, and the cost-benefit of using CMR is unexplored.
In this international multi-centre longitudinal pre- and post-CMR study, we will prospectively evaluate the incremental impact of CMR on clinical decision-making in patients with Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA). 384 patients will be recruited from 5 hospitals in the UK and Australia who undergoing CMR for further assessment. Prospective documentation from the treating clinician will determine diagnosis, diagnostic certainty and management pre- versus post-CMR. Predictors of a diagnostic CMR will be identified, and the incidence of further heart attack and major bleeding will be prospectively documented. Finally, the 'number-needed-to-test' and cost-efficacy of CMR will be evaluated.
REC name
North East - Tyne & Wear South Research Ethics Committee
REC reference
20/NE/0218
Date of REC Opinion
18 Nov 2020
REC opinion
Further Information Favourable Opinion