The Role of Cardiovascular Magnetic Resonance in Patients With Non-ST- Elevation- Myocardial Infarction

Study Overview
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Brief Summary
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The goal of this prospective study is to evaluate the role of cardiovascular magnetic resonance (CMR) in patients with suspected non-ST elevation myocardial infarction (NSTEMI). The main endpoint is the reclassification rate, defined as the number of patients in whom the information provided by pre-angiography CMR affects the revascularization strategy or the final diagnosis. Participants will undergo to CMR before invasive coronary angiography (ICA).

Detailed Description
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All patients with NSTEMI eligible for the study undergo CMR prior to ICA. To avoid any delay in patients' treatment all examination will be analyzed by local trained staff at each center. All patients will thereafter undergo ICA and the standard of care (SOC) decision-making on revascularization strategy and diagnosis will be declared by the treating physician, which will be blinded to the participation of the patients in the study and about CMR results. The treating physician will also declare patient's next management according to ICA results. After having declared the diagnosis, the treating physician will then be informed about the CMR findings. Therefore, according to CMR results the treating physician may eventually modify the initial diagnosis and management. Treatment plan modifications include difference in the identification of the culprit lesion, referring the patient to medical therapy instead of a revascularization procedure or viceversa, switching from a percutaneous to a surgical revascularization procedure or viceversa, or need for further cardiac or non-cardiac investigations. Initial diagnosis includes confirmed NSTEMI or all other possible alternative diagnosis and proposed additional diagnostic examination(s) for further differential diagnosis. The CMR-modified SOC (CMR-SOC) and diagnosis made considering CMR results will be collected.

Official Title
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The Role of Cardiovascular Magnetic Resonance in Patients With Non-ST- Elevation- Myocardial Infarction: the TITAN-MRI Study

Conditions
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Non-ST Elevation Myocardial Infarction (NSTEMI)

Intervention / Treatment
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* Diagnostic Test: Cardiovascular Magnetic Resonance


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years old Presence of criteria for acute myocardial infarction according to the Fourth Universal Definition of Myocardial Infarction: Signs and symptoms of myocardial ischemia Detection of acute myocardial injury defined as a rise and/or fall of high-sensitivity cardiac Troponin (hs-cTn) values with at least one value above the 99th percentile Upper Reference Limit at baseline or after presentation. Patients scheduled for ICA. Written informed consent. Exclusion Criteria: Patients diagnosed with myocardial infarction with ST segment elevation. Very High-risk NSTEMI patients according to 2020 ESC Guidelines on Acute Coronary Syndromes: Haemodynamic instability Cardiogenic shock Recurrent/refractory chest pain despite medical treatment Life-threatening arrhythmias Mechanical complications of MI Acute heart failure clearly related to NSTEMI ST-segment depression>1mm/6 leads plus ST-segment elevation aVR and/or V1. Legally incompetent to provide informed consent Participation in another clinical study. Regular known contraindications to CMR at time of inclusion such as: Severe renal impairment (eGFR < 30 ml / min / 1,73 m2) or on dialysis treatment Claustrophobia Known pregnancy or breast-feeding patients Non MR compatible devices Known allergy to Gadolinium

Ages Eligible for Study
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Minimum Age: 18 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 |
| --- | --- |
| Experimental: NSTEMI patients<br>Patients will undergo CMR before ICA | Diagnostic Test: Cardiovascular Magnetic Resonance<br>* All NSTEMI patients will undergo to CMR before invasive coronary intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reclassification rate | number of patients in whom the information provided by CMR affects the final diagnosis | immediately after invasive coronary angiography | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Culprit lesion identification | ability of CMR to detect culprit lesion | during invasive coronary angiography | 
| Revascularization strategy | number of patients in whom CMR affects the revascularization strtegy | immediately after invasive coronary angiography | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cardiovascular magnetic resonance, Myocardial Infaction, Invasive Coronary Angiography