Table 1

Consensus statements (modified survey)

Statement
1
  • The following statements relate to the ability of CMR to identify patients who have a poor prognosis after PPCI:

    1. CMR markers (eg, impaired LV function, large infarct size, microvascular obstruction) better identify patients with a poor prognosis after PPCI than markers based on echocardiography.

    2. Better identification of patients with a poor prognosis after PPCI allows these patients to be followed up more appropriately and treated more aggressively.

    3. More appropriate follow-up and more aggressive treatment in these patients are expected to lead to a reduced risk of MACE in the long term.

2
  • The following statements relate to the ability of CMR to identify patients who have a good prognosis after PPCI:

    1. CMR markers (eg, normal LV function, high myocardial salvage, no microvascular obstruction, no residual ischaemia) better identify patients with a good prognosis after PPCI than markers based on echocardiography.

    2. Better identification of patients with a good prognosis after PPCI allows these patients to be followed up less frequently.

    3. Less-frequent follow-up in these patients is expected to lead to less NHS resource use in the long term.

3
  • The following statements relate to the ability of CMR to identify the causes of OHCA in patients who undergo an emergency angiogram:

    1. CMR better identifies the cause of OHCA (eg, large myocardial infarction, ARVC, aberrant coronary arteries, HCM) than echocardiography.

    2. Better identification of the cause of OHCA allows treatment to be optimised for these patients (eg, defibrillator for primary arrhythmia or percutaneous coronary intervention) or their family members (eg, genetic screening and counselling, primary prevention).

    3. The ability to optimise treatment for these patients or family members is expected to lead to a reduced risk of MACE in the long term.

4
  • The following statements relate to the ability of CMR to identify patients with VSD after myocardial infarction:

    1. CMR identifies the location and characteristics of postinfarct VSD better than echocardiography.

    2. Better identification of the location and characteristics of postinfarct VSD guides the optimal management of these patients.

    3. Optimal management of patients with postinfarct VSD is expected to lead to a reduced risk of MACE in the long term.

5
  • The following statements relate to the ability of CMR to differentiate myocardial infarction from other diagnoses in patients found to have unobstructed coronary arteries on emergency angiography:

    1. Unlike echocardiography, CMR can provide a definitive ischaemic diagnosis (eg, myocardial infarction with spontaneous reperfusion or distal embolization) or a non-ischaemic diagnosis (eg, myocarditis, Takotsubo cardiomyopathy, aortic dissection) in patients with unobstructed coronary arteries on angiography.

    2. A definitive diagnosis results in a patient treatment plan appropriate for that diagnosis.

    3. A treatment plan appropriate for the diagnosis is expected to lead to a reduced risk of MACE in the long term.

6
  • The following statements relate to the ability of CMR to identify patients at high risk for sudden cardiac death after PPCI who would benefit most from an implantable cardiac device:

    1. CMR identifies PPCI patients who are at high risk for sudden cardiac death better than echocardiography.

    2. Better identification of PPCI patients at high risk for sudden cardiac death allows optimal patient selection for an implantable cardiac device (ICD or CRT).

    3. Optimal patient selection for an implantable cardiac device is expected to lead to a reduced risk of MACE in these patients in the long term.

7
  • The following statements relate to the ability of CMR to identify patients who would not benefit from CRT after PPCI:

    1. CMR identifies patients who would not benefit from CRT better than echocardiography.

    2. The ability to identify patients who would not benefit from CRT would reduce CRT use in patients who do not need it.

    3. Reducing CRT use in patients who do not need it is expected to lead to reduced risk of MACE in these patients in the long term.

8
  • The following statements relate to the ability of CMR to assess ischaemia and viability in patients with multivessel disease:

    1. CMR assesses ischaemia and viability of the myocardium better than echocardiography.

    2. Better assessment of ischaemia and viability of the myocardium optimises the revascularisation strategy for patients with multivessel disease and avoids additional diagnostic tests.

    3. The ability to optimise the revascularisation strategy for patients with multivessel disease is expected to lead to a reduced risk of MACE in the long term.

9
  • The following statements relate to the ability of CMR to identify patients with postinfarct LV thrombus:

    1. CMR identifies postinfarct LV thrombus better than transthoracic echocardiography.

    2. Better detection of postinfarct LV thrombus in PPCI patients allows more affected patients to be treated with anticoagulation therapy.

    3. Treatment with anticoagulation therapy in patients with postinfarct LV thrombus is expected to lead to a reduced risk of MACE in the long term.

10
  • The following statements relate to the ability of CMR to detect incidental cardiac and non-cardiac findings if offered routinely to patients who undergo an emergency angiogram:

    1. CMR identifies more incidental cardiac/non-cardiac findings than echocardiography.

    2. Improved detection of potentially significant incidental findings allows affected patients to be investigated further and/or treated.

    3. Further investigation and treatment are expected to reduce the risk of MACE/increase overall survival in affected patients in the long term.

  • ARVC, arrhythmogenic right ventricular cardiomyopathy; CMR, cardiovascular magnetic resonance; CRT, cardiac resynchronization therapy; HCM, hypertrophic cardiomyopathy; ICD, implantable cardioverter defibrillator; LV, left ventricular; MACE, major adverse cardiovascular events; NHS, National Health Service; OHCA, out-of-hospital cardiac arrest; PPCI, primary percutaneous coronary intervention; VSD, ventricular septal defect.