Copyright © Italian Federation of Cardiology. Unauthorized reproduction of this article is prohibited. The clue of ST-elevation myocardial infarction by means of integrated non-invasive imaging Filippo Cademartiri a,b , Alessandro Palumbo a , Erica Maffei a , Chiara Martini a , Alberta Cattabiani a and Annachiara Aldrovandi a We describe the case of a 24-year-old man who presented at our emergency department with ST-elevation myocardial infarction (STEMI). The patient showed no coronary artery disease on conventional coronary angiography (CAG). Computed tomography coronary angiography (CTCA) and cardiac magnetic resonance (MR) performed thereafter allowed the highly probable diagnosis of the culprit lesion (i.e. vulnerable plaque) and of the infarcted area. We demonstrated the impact of integrated non-invasive imaging in defining the diagnosis of STEMI with normal coronary arteries on CAG. J Cardiovasc Med 12:184–185 Q 2011 Italian Federation of Cardiology. Journal of Cardiovascular Medicine 2011, 12:184–185 Keywords: computed tomography coronary angiography, diagnosis, magnetic resonance, STEMI a Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy and b Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands Correspondence to Dr Filippo Cademartiri, MD, PhD, Department of Radiology, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100 Parma, Italy Tel: +39 0521 703516; fax: +39 0521 704838; e-mail: filippocademartiri@hotmail.com Received 26 August 2009 Revised 13 October 2009 Accepted 30 October 2009 A 24-year-old man was admitted to the emergency department after an episode of acute chest pain radiating to the left arm and shortness of breath. ECG showed ST elevation, inferior Q waves and negative T waves in D2, D3 and aVF. Myocardial biomarkers were positive with a creatine kinase-MB (CK-MB) peak of 12.8 ng/ml. The Images in cardiovascular medicine Fig. 1 No significant coronary artery disease was found on conventional coronary angiography in the left (a) and right (b, c) coronary tree (d – f). Overview of cardiac MRI. T2-weighted imaging using dark-blood TSE shows a focal area of hyperintensity arising from oedema in the inferior wall of the left ventricle that corresponds to a small area of acute ischaemia in the territory of the right coronary artery (arrowhead in d). Postgadolinium delayed enhancement imaging confirms the finding in long-axis and short-axis projections (arrowheads in e and f). MRI, magnetic resonance imaging; TSE, turbo-spin echo. 1558-2027 ß 2011 Italian Federation of Cardiology DOI:10.2459/JCM.0b013e328334c789