The Supplementary Role of Non-invasive Imaging to Routine Clinical Practice in Suspected Non-ST-elevation Myocardial Infarction

Exclusion Criteria

• •Ongoing severe ischemia requiring immediate invasive coronary angiography
• •Shock (mean arterial pressure \< 60 mmHg) or severe heart failure (Killip Class ≥ III)
• •ST-elevation myocardial infarction (ST-elevation in 2 contiguous leads: ≥0.2mV in men or ≥0.15 mV in women in leads V2-V3 and/or ≥0.1 mV in other leads or new left bundle branch block)
• •Chest pain highly suggestive of non-cardiac origin:
• •* Acute aortic dissection
• •* Acute pulmonary embolism (high risk patient defined as Wells score \>6)
• •* Musculoskeletal or gastro-intestinal pain
• •* Other (pneumothorax, pneumonia, rib fracture, etc.)
• •Previously known coronary artery disease, defined as:
• •* Any non-invasive diagnostic imaging test positive for coronary artery disease
• •* Coronary stenosis \>50% on any previous invasive coronary angiography or computed tomography angiography
• •* Documented previous myocardial infarction
• •* Documented previous coronary artery revascularization
• •* Known cardiomyopathy
• •Pregnancy
• •Life threatening arrhythmia on the cardiac emergency department or prior to presentation
• •Tachycardia (≥100/bpm)
• •Atrial fibrillation
• •Angina pectoris secondary to anemia (\<5.6 mmol/L), untreated hyperthyroidism, aortic valve stenosis (aortic valve area ≤ 1.5 cm2), or severe hypertension (\>200/110 mmHg)
• •Life expectancy \<1 year (malignancy, etc.)
• •Contraindications to cardiovascular magnetic resonance imaging: metallic implant (vascular clip, neuro-stimulator, cochlear implant), pacemaker or implantable cardiac defibrillator, claustrophobia