Research on Infarction With Open Arteries Using OCT and CMR

Study Overview
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Brief Summary
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The purpose of this study is to determine the prevalence of plaque disruption and to assess the composition of disrupted plaques in patients with myocardial infarction (MI) and non-obstructive coronary artery disease (CAD) using optical coherence tomography (OCT). Additionally, cardiac magnetic resonance imaging (CMR) will be used to detect myocardial abnormalities, which will be correlated to OCT findings to gain insight into the mechanisms of MI in patients with non-obstructive coronary artery disease (i.e. open arteries).

Detailed Description
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In this single center, observational study, patients of both sexes with MI who are referred for cath will be enrolled. Those who have no obstructive CAD on clinically indicated coronary angiography, defined as no stenosis of >50% in any major epicardial vessel, will undergo coronary OCT just after the clinically indicated diagnostic angiogram, and CMR within 1 week, typically within 72-96 hours. Participants will be followed for clinical events for at least 1 year. 20 fully eligble participants will be recruited at NYU Langone Medical Center and Bellevue Hospital Center among a projected 200 enrolled patients.

Official Title
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Research on Infarction With Open Arteries Using OCT and CMR (RIO)

Conditions
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Myocardial Infarction

Intervention / Treatment
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* Device: OCT
* Procedure: CMR
* Drug: contrast agent, Gadolinium


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Acute ischemic symptoms compatible with diagnosis of acute coronary syndrome (ACS) (chest pain or anginal equivalent symptoms at rest or new onset exertional anginal equivalent symptoms) Objective evidence of myocardial infarction (either or both of the following): Elevation of troponin to above the laboratory upper limit of normal (ULN) or ST segment elevation of ≥1mm on 2 contiguous ECG leads Willing to provide informed consent and comply with all aspects of the protocol Age ≥ 21 years Exclusion Criteria: Stenosis ≥50% of any major epicardial vessel on invasive angiography, as determined by the angiographer at the time of clinically ordered cardiac cath. History of known obstructive CAD at angiography, including history of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) Recent use of vasospastic agents, such as cocaine, triptans, ergot alkaloids (≤1 month) Alternate explanation for troponin elevation, such as hypertensive urgency, acute exacerbation of heart failure, chronic elevation due to kidney disease, pulmonary embolism, cardiac trauma Coronary dissection apparent on angiography Excessive coronary tortuosity which, in the opinion of the angiographer, increases the risks of OCT eGFR<30 or contraindication to additional contrast needed for OCT in the opinion of the angiographer or treating physician Contraindication to MRI (including but not limited to MRI-incompatible metal implants or foreign bodies) Pregnancy Thrombolytic therapy for STEMI (qualifying event)

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: MI without obstructive CAD<br>MI without obstructive CAD, with OCT and CMR imaging | Device: OCT<br>* Optical coherence tomography (OCT): Intracoronary imaging for amount and type of plaque as well as plaque rupture, ulceration, dissection and/or thrombosis.<br>Procedure: CMR<br>* Cardiac magnetic resonance imaging (CMR): MRI of the heart to identify areas of infarction (damage) and/or edema (smelling)<br>Drug: contrast agent, Gadolinium<br>* Gadolinium contrast will be administered during CMR<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The prevalence of plaque disruption |  | 1 Week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence and pattern of LGE and myocardial edema Prevalence of different plaque types according to OCT Proportion of patients with identifiable MI etiology based on study testing |  | 1 week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CAD, Myocardial Infarction