Notaufnahme – Platz für Kardio-MRT und Kardio-CT?

Abstract

Coronary Artery Disease (CAD), subsequent myocardial infarction (MI) and heart failure constitute a leading cause of death in the western world. Myocardial ischemia is the major component underlying these cardiovascular diseases. Acute coronary syndrome (ACS) is heterogenic and comprises acute ST-Elevation Myocardial Infarction (STEMI), Non-ST-Elevation Myocardial Infarction (NSTEMI) and unstable angina. Whilst ECG and laboratory diagnostics are first line tests to perform it is well recognized that non-invasive techniques such as cardiac magnetic resonance (CMR) and computer tomography (CT) can be of additional value particularly in the setting of unstable angina.

CMR brings the promise of exact quantification of myocardial function, accurate tissue characterisation including assessment of myocardial oedema and necrosis and assessment of functional severity of coronary artery stenoses by first pass perfusion in a single examination. CT on the other hand offers, „triple rule out” of pulmonary embolism, aortic dissection and myocardial infarction in a relatively quick and easy examination. This article will review the indications, accuracy, and clinical utility of CMR and CT and their value in the accident and emergency department for the diagnostic assessment of ACS. Finally we will give an outlook on how this field might evolve in the future.

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