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

Abstract

ObjectiveTo 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.DesignFormal 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).ParticipantsFormulation 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.ResultsThirty-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.ConclusionThere was consensus that CMR leads to clinically important changes in management in five subgroups of patients who activate the PPCI pathway.

A national registry to assess the value of cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention pathway activation: a feasibility cohort study

“…In particular, we were uncertain if we could (1) easily identify the eligible population, (2) implement a 'light-touch' consent system across multiple hospitals and (3) extract and link data sets from multiple HISs in different hospitals. We also wanted (4) to provide a reliable estimate of the CMR rate in patients who activate the PPCI pathway and (5) to define a 'proxy' primary composite outcome, acceptable to cardiologists and other stakeholders (e.g. clinical commissioners) as representing a clinically important change in management as a result of an eligible patient having undergone CMR (e.g.…”

“…The survey was modified by members of the working group as agreed in the face-to-face meeting (see Appendix 4). 4 The expert panel completed the modified survey independently and rated the statements a second time.…”

“…We used this approach because we knew from a preliminary scoping of the literature that there were few studies that reported the impact of CMR on patient management. 4 We used clinical expertise to define 'clinical events' that captured the important changes in management and a clinical coder to identify collaborated with codes (ICD-10 31 and the OPCS Classification of Intervention and Procedures 32 ) corresponding to these clinical events. We then searched for these codes in hospital episode data for participants in the cohort study during the 12 months following the index admission (PPCI pathway activation).…”

“…There was no consensus that any of the other statements described a change in management that was not clinically important. 4 The final statements from the modified survey are in Appendix 8.…”

“…2,3 Similarly, few studies have assessed how CMR changes patient management, despite the fact that cardiologists believe that CMR brings about important changes in management. 4…”