Cardiac Magnetic Resonance in the Emergency Department to Evaluate Patients for Possible Acute Coronary Syndrome

The use of cardiac magnetic resonance (CMR) imaging has recently been demonstrated to be a useful adjunct in the evaluation of emergency department (ED) patients with acute chest pain. This modality allows the assessment of non-ischemic causes of chest pain, early ischemic changes (T2-weighted imaging for edema), resting and stress perfusion abnormalities, resting and stress wall motion abnormalities, and assessment for scar formation with delayed enhancement. This comprehensive information appears most useful when evaluating higher complexity patients such as those at intermediate or high risk for ACS. In these more complex patients, the use of CMR is supported by appropriateness criteria, and in recent studies appears to be a cost-effective alternative to inpatient evaluation when combined with observation unit care.