title: Imaging diagnoses and outcome in patients presenting for primary angioplasty but no obstructive coronary artery disease.
abstract: A proportion of patients with suspected ST-elevation myocardial infarction (STEMI) presenting for primary percutaneous coronary intervention (PPCI) do not have obstructive coronary disease and other conditions may be responsible for their symptoms and ECG changes. In this study, we set out to determine the prevalence and aetiology of alternative diagnoses in a large PPCI cohort as determined with multimodality imaging and their outcome.
  
  
  
  From 2009 to 2012, 5238 patients with suspected STEMI were referred for consideration of PPCI. Patients who underwent angiography but had no culprit artery for revascularisation and no previous history of coronary artery disease were included in the study. Troponin values, imaging findings and all-cause mortality were obtained from hospital and national databases.
  
  
  
  A total of 575 (13.0%) patients with a mean age of 58±15 years (69% men) fulfilled the inclusion criteria. A specific diagnosis based on imaging was made in 237 patients (41.2%) including cardiomyopathies (n=104, 18%), myopericarditis (n=48, 8.4%), myocardial infarction/other coronary abnormality (n=27, 4.9%) and severe valve disease (n=23, 4%). Pulmonary embolism and type A aortic dissection were identified in seven (1.2%) and four (0.7%) cases respectively. A total of 40 (7.0%) patients died over a mean follow-up of 42.6 months.
  
  
  
  A variety of cardiac and non-cardiac conditions are prevalent in patients presenting with suspected STEMI but culprit-free angiogram, some of which may have adverse outcomes. Further imaging of such patients could thus be useful to help in appropriate management and follow-up.
authors.affiliation: Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Tarun K
authors.initials: TK
authors.lastname: Mittal
authors.affiliation: Department of Imaging, Mater Dei University Hospital, Malta, Malta.
authors.forename: Luise
authors.initials: L
authors.lastname: Reichmuth
authors.affiliation: Department of Imaging, Imperial College NHS Healthcare Trust, London, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Ariff
authors.affiliation: Department of Imaging, Glenfield Hospital, University Hospital of Leicester, Leicester, UK.
authors.forename: Praveen P G
authors.initials: PP
authors.lastname: Rao
authors.affiliation: Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Aigul
authors.initials: A
authors.lastname: Baltabaeva
authors.affiliation: Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Shelley
authors.initials: S
authors.lastname: Rahman-Haley
authors.affiliation: Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Tito
authors.initials: T
authors.lastname: Kabir
authors.affiliation: Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Joyce
authors.initials: J
authors.lastname: Wong
authors.affiliation: Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Miles
authors.initials: M
authors.lastname: Dalby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D004452:Echocardiography; D004739:England / Q000453:epidemiology; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D062645:Percutaneous Coronary Intervention; D010493:Pericarditis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D014336:Troponin / Q000097:blood; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy
chemical_list: D015415:Biomarkers; D014336:Troponin