OBJECTIVES: This study was designed to determine the diagnostic value of adeno sine cardiac magnetic resonance(CMR) in troponin-negative patients with chest p ain. BACKGROUND: We hypothesized that adenosine CMR could determine which tropon in-negative patients with chest pain in an emergency department have coronary a rtery disease(CAD) or future adverse cardiac events. METHODS: Adenosine stress C MR was performed on 135 patients who presented to the emergency department with chest pain and had acute myocardial infarction(MI) excluded by troponin-I. The main study outcome was detecting any evidence of significant CAD. Patients were contacted at one year to determine the incidence of significant CAD defined as c oronary artery stenosis >50%on angiography, abnormal correlative stress test, n ew MI, or death. RESULTS: Adenosine perfusion abnormalities had 100%sensitivity and 93%specificity as the single most accurate component of the CMR examinatio n. Both cardiac risk factors and CMR were significant in Kaplan-Meier analysis( log-rank test, p=0.0006 and p< 0.0001, respectively). However, an abnormal CMR added significant prognostic value in predicting future diagnosis of CAD, MI, or death over clinical risk factors. In receiver operator curve analysis, adenosin e CMR was a more accurate predictor than cardiac risk factors(p< 0.002). CONCLUS IONS: In patients with chest pain who had MI excluded by troponin-I and non-di agnostic electrocardiograms, an adenosine CMR examination predicted with high se nsitivity and specificity which patients had significant CAD during one-year fo llow-up. Furthermore, no patients with a normal adenosine CMR study had a subse quent diagnosis of CAD or an adverse outcome.
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