Misclassification rate of the angiographically identified culprit lesion in NSTEMI

Abstract Background Correct identification of the culprit lesion in NSTEMI is essential, particular for patients whom a culprit-only strategy attractive (e.g., elderly and frail patients). However, when identifying NSTEMI, angiography can be ambiguous correct therefore challenging based on angiography, ECG- echocardiographic changes alone (standard-of-care). In fact, this challenge remains unresolved continuous limitation guidelines few clinical trials investigating revascularization NSTEMI. Purpose We aimed to investigate agreement between cardiac magnetic resonance (CMR) optical coherence tomography (OCT) non-ST segment elevation myocardial infarction (NSTEMI). Methods two centres we prospectively enrolled 104 patients. CMR was performed prior angiography. Operators, blinded CMR, identified standard-of-care. OCT subsequently operator-suspected lesions stenoses ≥50% diameter. were reviewed angiographic identification. Myocardial oedema considered reference standard culprit. absence oedema, used. case multiple suspected OCT-lesions, hierarchical criteria used: acute thrombus > plaque rupture with cavity organising dissection calcific nodule. Results The majority included male (75%) at mean 63 years age. Obstructive disease observed 85 (82%) patients, which 53 (51%) had multivessel disease. On patient-level, 90 (87%) CMR/OCT only 74 This constituted moderate overall positive predictive value found inferior lesion. lesion-level, different than 12 (16%) Of these, one patient did not receive true Moreover, 14 without an culprit, 7 (50%) Thus, including standard-of-care falsely 35 (34%) patients: false negatives, 16 misclassified culprits lesion-level (Figure 1). Specifically, 13% proximal segments, provided added diagnostic value. Conclusions Angiography three respect both presence location. complemented cases underscores aiding treatment diagnosis Funding Acknowledgement Type funding sources: Public hospital(s). Main source(s): Research Grant Rigshospitalet, Copenhagen University Hospital, DenmarkNovo Nordisk Foundation, Denmark