title: Safety and diagnostic accuracy of stress cardiac magnetic resonance imaging vs exercise tolerance testing early after acute ST elevation myocardial infarction.
abstract: 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).
  
  
  METHODS
  Cross sectional observational study in a university teaching hospital.
  
  
  METHODS
  35 patients admitted with first acute STEMI.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Academic Unit of Cardiovascular Medicine, G-floor, Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. j.greenwood@leeds.ac.uk
authors.forename: J P
authors.initials: JP
authors.lastname: Greenwood
authors.forename: J F
authors.initials: JF
authors.lastname: Younger
authors.forename: J P
authors.initials: JP
authors.lastname: Ridgway
authors.forename: M U
authors.initials: MU
authors.lastname: Sivananthan
authors.forename: S G
authors.initials: SG
authors.lastname: Ball
authors.forename: S
authors.initials: S
authors.lastname: Plein
mesh_terms: D000241:Adenosine; D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000628:therapy; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D009204:Myocardial Revascularization; D018579:Patient Selection
chemical_list: D000241:Adenosine