Safety and diagnostic accuracy of stress cardiac magnetic resonance imaging vs exercise tolerance testing early after acute ST elevation myocardial infarction.

OBJECTIVE To determine the safety and diagnostic accuracy of adenosine-stress cardiac magnetic resonance (CMR) perfusion imaging early after acute ST elevation myocardial infarction (STEMI) compared with standard exercise tolerance testing (ETT). DESIGN AND SETTING Cross sectional observational study in a university teaching hospital. PATIENTS 35 patients admitted with first acute STEMI. INTERVENTIONS All patients underwent a CMR imaging protocol which included rest and adenosine-stress perfusion, viability, and cardiac functional assessment. All patients also had an ETT (modified Bruce protocol) and x ray coronary angiography. MAIN OUTCOME MEASURES Safety and diagnostic accuracy of adenosine-stress perfusion CMR vs ETT early after STEMI in identifying patients with significant coronary stenosis (>or=70%) and the need for coronary revascularisation. Also, to determine if CMR can distinguish between ischaemia in the peri-infarct zone and ischaemia in remote myocardium. RESULTS CMR imaging was well tolerated (all patients completed the protocol) and no complications occurred. CMR was more sensitive (86% vs 48%, p = 0.0074) and more specific than ETT (100% vs 50%, p<0.0001) for detecting significant coronary stenosis, and more sensitive for predicting revascularisation (94% vs 56%, p = 0.039). Inducible ischaemia in the infarct related artery territory was seen in 21 of 35 patients and was associated with smaller infarct size and less transmurality of infarction. CONCLUSIONS Adenosine-stress CMR imaging is safe early after acute STEMI and identifies patients with significant coronary stenosis more accurately than ETT.