Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging

Arch Cardiovasc Dis. 2011 Oct;104(10):509-17. doi: 10.1016/j.acvd.2011.05.004. Epub 2011 Sep 1.


Background: Acute coronary syndrome (ACS) with normal coronary angiography is a frequent clinical situation with an uncertain prognosis. Cardiac magnetic resonance imaging (CMRI) is a powerful tool for differential diagnosis between myocardial infarction (MI), acute myocarditis and Tako-tsubo cardiomyopathy (TTC). Data are sparse regarding the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI.

Aims: To evaluate the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI, with a 1-year follow-up.

Methods: Eighty-seven consecutive patients (mean age, 53 years; 40.2% men) presenting an ACS with troponin elevation and normal coronary arteries by angiography were prospectively included. All patients underwent CMRI at 3-Tesla. Adverse events were recorded with 1-year follow-up.

Results: A likely aetiology for the acute clinical presentation was established by CMRI in 63.2% of patients (22.7% MI, 26.4% acute myocarditis, 11.5% TTC). During follow-up, one patient in the MI group had a stroke (1.2%). In the myocarditis group, there was one initial cardiogenic shock, one episode of congestive heart failure (1.2%) and nine patients had recurrent chest pain without troponin elevation (10.3%). Two TTC group patients initially presented with cardiogenic shock (2.4%); there were no other adverse events in this group during follow-up. In the remaining 36.7% patients, no clear diagnosis could be identified by CMRI, and no adverse events occurred during follow-up.

Conclusion: CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain the diagnosis and adapt treatment in a large proportion of cases. Nonetheless, patients with no abnormalities identified by CMRI have an excellent evolution.

MeSH terms

  • Acute Coronary Syndrome / blood
  • Acute Coronary Syndrome / diagnosis*
  • Adult
  • Aged
  • Biomarkers / blood
  • Chi-Square Distribution
  • Coronary Angiography*
  • Diagnosis, Differential
  • Disease Progression
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / diagnosis*
  • Myocarditis / blood
  • Myocarditis / diagnosis*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Takotsubo Cardiomyopathy / blood
  • Takotsubo Cardiomyopathy / diagnosis*
  • Time Factors
  • Troponin I / blood
  • Up-Regulation


  • Biomarkers
  • Troponin I