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

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.