TY - JOUR
T1 - Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease
AU - Antiochos, Panagiotis
AU - Ge, Yin
AU - Heydari, Bobak
AU - Steel, Kevin
AU - Bingham, Scott
AU - Abdullah, Shuaib M.
AU - Mikolich, J. Ronald
AU - Arai, Andrew E.
AU - Bandettini, W. Patricia
AU - Patel, Amit R.
AU - Farzaneh-Far, Afshin
AU - Heitner, John F.
AU - Shenoy, Chetan
AU - Leung, Steve W.
AU - Gonzalez, Jorge A.
AU - Shah, Dipan J.
AU - Raman, Subha V.
AU - Ferrari, Victor A.
AU - Schulz-Menger, Jeanette
AU - Stuber, Matthias
AU - Simonetti, Orlando P.
AU - Kwong, Raymond Y.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/1
Y1 - 2022/1
N2 - Objectives: This study sought to determine whether stress cardiac magnetic resonance (CMR) provides clinically relevant risk reclassification in patients with known coronary artery disease (CAD) in a multicenter setting in the United States. Background: Despite improvements in medical therapy and coronary revascularization, patients with previous CAD account for a disproportionately large portion of CV events and pose a challenge for noninvasive stress testing. Methods: From the Stress Perfusion Imaging in the United States (SPINS) registry, we identified consecutive patients with documented CAD who were referred to stress CMR for evaluation of myocardial ischemia. The primary outcome was nonfatal myocardial infarction (MI) or cardiovascular (CV) death. Major adverse CV events (MACE) included MI/CV death, hospitalization for heart failure or unstable angina, and late unplanned coronary artery bypass graft. The prognostic association and net reclassification improvement by ischemia for MI/CV death were determined. Results: Out of 755 patients (age 64 ± 11 years, 64% male), we observed 97 MI/CV deaths and 210 MACE over a median follow-up of 5.3 years. Presence of ischemia demonstrated a significant association with MI/CV death (HR: 2.30; 95% CI: 1.54-3.44; P < 0.001) and MACE (HR: 2.24 ([95% CI: 1.69-2.95; P < 0.001). In a multivariate model adjusted for CV risk factors, ischemia maintained strong association with MI/CV death (HR: 1.84; 95% CI: 1.17-2.88; P = 0.008) and MACE (HR: 1.77; 95% CI: 1.31-2.40; P < 0.001) and reclassified 95% of patients at intermediate pretest risk (62% to low risk, 33% to high risk) with corresponding changes in the observed event rates of 1.4% and 5.3% per year for low and high post-test risk, respectively. Conclusions: In a multicenter cohort of patients with known CAD, CMR-assessed ischemia was strongly associated with MI/CV death and reclassified patient risk beyond CV risk factors, especially in those considered to be at intermediate risk. Absence of ischemia was associated with a <2% annual rate of MI/CV death.
AB - Objectives: This study sought to determine whether stress cardiac magnetic resonance (CMR) provides clinically relevant risk reclassification in patients with known coronary artery disease (CAD) in a multicenter setting in the United States. Background: Despite improvements in medical therapy and coronary revascularization, patients with previous CAD account for a disproportionately large portion of CV events and pose a challenge for noninvasive stress testing. Methods: From the Stress Perfusion Imaging in the United States (SPINS) registry, we identified consecutive patients with documented CAD who were referred to stress CMR for evaluation of myocardial ischemia. The primary outcome was nonfatal myocardial infarction (MI) or cardiovascular (CV) death. Major adverse CV events (MACE) included MI/CV death, hospitalization for heart failure or unstable angina, and late unplanned coronary artery bypass graft. The prognostic association and net reclassification improvement by ischemia for MI/CV death were determined. Results: Out of 755 patients (age 64 ± 11 years, 64% male), we observed 97 MI/CV deaths and 210 MACE over a median follow-up of 5.3 years. Presence of ischemia demonstrated a significant association with MI/CV death (HR: 2.30; 95% CI: 1.54-3.44; P < 0.001) and MACE (HR: 2.24 ([95% CI: 1.69-2.95; P < 0.001). In a multivariate model adjusted for CV risk factors, ischemia maintained strong association with MI/CV death (HR: 1.84; 95% CI: 1.17-2.88; P = 0.008) and MACE (HR: 1.77; 95% CI: 1.31-2.40; P < 0.001) and reclassified 95% of patients at intermediate pretest risk (62% to low risk, 33% to high risk) with corresponding changes in the observed event rates of 1.4% and 5.3% per year for low and high post-test risk, respectively. Conclusions: In a multicenter cohort of patients with known CAD, CMR-assessed ischemia was strongly associated with MI/CV death and reclassified patient risk beyond CV risk factors, especially in those considered to be at intermediate risk. Absence of ischemia was associated with a <2% annual rate of MI/CV death.
KW - coronary artery disease
KW - ischemia
KW - risk reclassification
KW - stress cardiac magnetic resonance
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U2 - 10.1016/j.jcmg.2021.06.025
DO - 10.1016/j.jcmg.2021.06.025
M3 - Article
C2 - 34419400
AN - SCOPUS:85119299848
SN - 1936-878X
VL - 15
SP - 60
EP - 71
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 1
ER -