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Formal consensus to identify clinically important changes in management resulting from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway
  1. Maria Pufulete1,
  2. Rachel C Brierley1,
  3. Chiara Bucciarelli-Ducci2,
  4. John P Greenwood3,
  5. Stephen Dorman2,
  6. Richard A Anderson4,
  7. Jessica Harris1,
  8. Elisa McAlindon5,
  9. Chris A Rogers1,
  10. Barnaby C Reeves1
  1. 1 Clinical Trials and Evaluation Unit, University of Bristol, Bristol, UK
  2. 2 NIHR Bristol Cardiovascular Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3 Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  4. 4 Department of Cardiology, University Hospitals of Wales, Cardiff, UK
  5. 5 Department of Cardiology, New Cross Hospital, Wolverhampton, UK
  1. Correspondence to Dr Maria Pufulete; maria.pufulete{at}bristol.ac.uk

Abstract

Objective To define important changes in management arising from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway.

Design Formal consensus study using literature review and cardiologist expert opinion to formulate consensus statements and setting up a consensus panel to review the statements (by completing a web-based survey, attending a face-to-face meeting to discuss survey results and modify the survey to reflect group discussion and completing the modified survey to determine which statements were in consensus).

Participants Formulation of consensus statements: four cardiologists (two CMR and two interventional) and six non-clinical researchers. Formal consensus: seven cardiologists (two CMR and three interventional, one echocardiography and one heart failure). Forty-nine additional cardiologists completed the modified survey.

Results Thirty-seven draft statements describing changes in management following CMR were generated; these were condensed into 12 statements and reviewed through the formal consensus process. Three of 12 statements were classified in consensus in the first survey; these related to the role of CMR in identifying the cause of out-of-hospital cardiac arrest, providing a definitive diagnosis in patients found to have unobstructed arteries on angiography and identifying patients with left ventricular thrombus. Two additional statements were in consensus in the modified survey, relating to the ability of CMR to identify patients who have a poor prognosis after PPCI and assess ischaemia and viability in patients with multivessel disease.

Conclusion There was consensus that CMR leads to clinically important changes in management in five subgroups of patients who activate the PPCI pathway.

  • Cardiovascular magnetic resonance
  • primary percutaneous coronary intervention
  • systematic review
  • formal consensus

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors MP determined the structure of the consensus process, conducted the literature review, formulated statements based on the literature review, was a member of the working group and wrote the manuscript.

    RB contributed to the consensus process, was a member of the working group, cowrote the manuscript and approved the final manuscript.

    CB-D conceived the overall feasibility study, contributed to the consensus process, was a member of the working group, revised the manuscript with respect to intellectual content and approved the final manuscript.

    JPG contributed to the consensus process, was a member of the working group, revised the manuscript with respect to intellectual content and approved the final manuscript.

    SD contributed to the consensus process, was a member of the working group, revised the manuscript with respect to intellectual content and approved the final manuscript.

    RAA was a member of the working group, revised the manuscript with respect to intellectual content and approved the final manuscript.

    JH reviewed the statistical analysis, was a member of the working group, revised the manuscript with respect to intellectual content and approved the final manuscript.

    EM contributed to the formulation of the consensus statements, revised the manuscript with respect to intellectual content and approved the final manuscript.

    CAR reviewed the analysis, was a member of the working group and approved the final manuscript.

    BCR is the chief investigator who conceived the overall feasibility study, including the consensus element, was a member of the working group, revised the manuscript with respect to intellectual content and approved the final manuscript.

  • Funding This study is part of a project funded by the National Institute of Health Research (NIHR) Health Services & Delivery Research (HS&DR 11/2003/58). The British Heart Foundation and NIHR Bristol Biomedical Research Unit for Cardiovascular Disease funded some staff time (CAR, CBD, JH, EM and BCR).

  • Disclaimer The views and opinions expressed are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, the UK NHS or the Department of Health.

  • Competing interests JPG has received a research grant from Philips Healthcare. The remaining authors declare that they have no competing interests.

  • Ethics approval NRES Committee South West-Central Bristol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The literature search based on the published search strategy, details of development of the consensus statements and the survey results can be obtained by contacting the corresponding author (maria.pufulete@bristol.ac.uk).

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