Trial reportCirculation. Cardiovascular imaging2023
Cardiac Magnetic Resonance Imaging Versus Invasive-Based Strategies in Patients With Chest Pain and Detectable to Mildly Elevated Serum Troponin: A Randomized Clinical Trial.
Trial report in Circulation. Cardiovascular imaging, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT01931852 (Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients With Acute Chest Pain and Detectable to Elevated Troponin), which is not on this map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients With Acute Chest Pain and Detectable to Elevated Troponin
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Representation of Older Adults and Women in Randomized Trials of Noninvasive Imaging for Chest Pain.Circulation. Cardiovascular imaging · 2025Pooled it
- Diagnostic performance of the Myocardial-Ischaemic-Injury index machine-learning algorithm in patients with an initial indeterminate troponin.Open heart · 2026Trial
- Cardiac magnetic resonance imaging reduces radiation exposure in emergency department patients with chest pain: A secondary analysis from the CMR IMPACT trial.The American journal of emergency medicine · 2026Trial
- Cardiac testing choices by physician specialty in the CMR-IMPACT trial.The American journal of emergency medicine · 2025Trial
- Article
- Differentiating Type 1 and Type 2 myocardial infarction using a machine learning algorithm and biomarkers.The American journal of emergency medicine · 2025Article
- SIRM/SIC consensus document on the management of patients with acute chest pain.La Radiologia medica · 2025Article
- Multimodality Non-Invasive Imaging Approach in Acute Coronary Syndrome: Diagnostic and Prognostic Assessment.Current cardiology reports · 2025Review
- High-sensitivity troponin T as a rule-out marker for myocardial inflammation detectable by CMR imaging.Open heart · 2025Article
- Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin.American heart journal plus : cardiology research and practice · 2025Article
- Diagnosing acute myocarditis in the emergency department-advancing cardiac MRI with a focus on low-field MR applications.Frontiers in radiology · 2025Review
- Recent Progress of Cardiac MRI for Nuclear Medicine Professionals.Nuclear medicine and molecular imaging · 2024Review
- Increased [Basic research in cardiology · 2024Article
Corrections and comments
- Erratum issued
Authors and funding
16 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundThe optimal diagnostic strategy for patients with chest pain and detectable to mildly elevated serum troponin is not known. The objective was to compare clinical outcomes among an early decision for a noninvasive versus an invasive-based care pathway.
methodsThe CMR-IMPACT trial (Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients with Acute Chest Pain and Detectable to Elevated Troponin) was conducted at 4 United States tertiary care hospitals from September 2013 to July 2018. A convenience sample of 312 participants with acute chest pain symptoms and a contemporary troponin between detectable and 1.0 ng/mL were randomized early in their care to 1 of 2 care pathways: invasive-based (n=156) or cardiac magnetic resonance (CMR)-based (n=156) with modification allowed as the patient condition evolved. The primary outcome was a composite including death, myocardial infarction, and cardiac-related hospital readmission or emergency visits.
resultsParticipants (N=312, mean age, 60.6 years, SD 11.3; 125 women [59.9%]), were followed over a median of 2.6 years (95% CI, 2.4-2.9). Early assigned testing was initiated in 102 out of 156 (65.3%) CMR-based and 110 out of 156 (70.5%) invasive-based participants. The primary outcome (CMR-based versus invasive-based) occurred in 59% versus 52% (hazard ratio, 1.17 [95% CI, 0.86-1.57]), acute coronary syndrome after discharge 23% versus 22% (hazard ratio, 1.07 [95% CI, 0.67-1.71]), and invasive angiography at any time 52% versus 74% (hazard ratio, 0.66 [95% CI, 0.49-0.87]). Among patients completing CMR imaging, 55 out of 95 (58%) were safely identified for discharge based on a negative CMR and did not have angiography or revascularization within 90 days. Therapeutic yield of angiography was higher in the CMR-based arm (52 interventions in 81 angiographies [64.2%] versus 46 interventions in 115 angiographies [40.0%] in the invasive-based arm [
conclusionsInitial management with CMR or invasive-based care pathways resulted in no detectable difference in clinical and safety event rates. The CMR-based pathway facilitated safe discharge, enriched the therapeutic yield of angiography, and reduced invasive angiography utilization over long-term follow-up. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01931852.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.