Greulich S, et al. - Researchers assessed adenosine stress cardiovascular magnetic resonance (CMR) as a diagnostic modality for identification of significant stenosis in infarct-related arteries. Two different types of perfusion defects could be seen: (a) larger than or (b) equal size as scar. They investigated if significant coronary stenosis is predicted by defect>scar, and if defect=scar predicts an unobstructed infarct-related artery, and whether angina symptoms have additional value in stratification. Among patients with previous myocardial infarction referred for work-up of myocardial ischemia undergoing adenosine stress CMR, only those were eligible for inclusion who had coronary angiography within 4 weeks of CMR. In infarct-related arteries, significant stenosis was highly predicted by a perfusion defect larger than scar. However, significant coronary stenosis was also demonstrated by more than a third of the patients with perfusion defect of equal size as scar. A high-risk of reinfarction was suggested as still viable (subendocardial) scars were evident in half of these patients. Only in patients with perfusion defects larger than scar, diagnostic accuracy seemed to increase due to the addition of angina symptoms.