Diagnostic accuracy and prognostic value of CMR in patients with suspected acute coronary syndrome: a meta-analysis

Abstract

Aims: Cardiovascular magnetic resonance (CMR) could be considered as first diagnostic test in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS), since up to one-third do not have obstructive coronary artery disease (CAD). This meta-analysis aimed to investigate (i) the diagnostic accuracy of CMR to detect obstructive CAD and NSTE-ACS, and (ii) the prognostic value of CMR in patients with suspected NSTE-ACS.

Methods and results: Pubmed, Embase, and Cochrane Library were searched (30 November 2024) for eligible studies. To determine the diagnostic accuracy of CMR prior to invasive coronary angiography, sensitivity, specificity, and likelihood ratios (LR+/-) were calculated for each endpoint. Data were pooled using a bivariate random-effects model. This meta-analysis was pre-registered in PROSPERO (CRD42024625306). Sixteen studies with 1386 patients were included. The pooled sensitivity and specificity to detect obstructive CAD (eight studies) were 85% (95%CI 78-91%) and 73% (95%CI 57-85%). The pooled LR+ and LR- were 3.20 (95%CI 1.78-5.73) and 0.20 (95%CI 0.11-0.36). The pooled sensitivity and specificity to diagnose NSTE-ACS (five studies) were 83% (95%CI 73-89%) and 89% (95%CI 72-96%). The pooled LR+ and LR- were 7.45 (95%CI 2.77-20.02) and 0.20 (95%CI 0.13-0.30). Finally, the pooled sensitivity and specificity for prognosis based on ACS-related outcomes (four studies) were 98% (95%CI 42-100%) and 85% (95%CI 65-95). The pooled LR+ and LR- were 6.55 (95%CI 2.45-17.54) and 0.03 (95%CI 0-1.54).

Conclusion: CMR can detect obstructive CAD and diagnose NSTE-ACS with excellent pooled sensitivity and specificity. CMR findings are strongly associated with clinical outcome in patients with suspected NSTE-ACS.

Keywords: acute coronary syndrome; cardiovascular magnetic resonance; coronary artery disease; diagnostic meta-analysis; prognosis.