Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease.

Details

Serval ID
serval:BIB_EE6E2D826966
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease.
Journal
JACC. Cardiovascular imaging
Author(s)
Antiochos P., Ge Y., Heydari B., Steel K., Bingham S., Abdullah S.M., Mikolich J.R., Arai A.E., Bandettini W.P., Patel A.R., Farzaneh-Far A., Heitner J.F., Shenoy C., Leung S.W., Gonzalez J.A., Shah D.J., Raman S.V., Ferrari V.A., Schulz-Menger J., Stuber M., Simonetti O.P., Kwong R.Y.
ISSN
1876-7591 (Electronic)
ISSN-L
1876-7591
Publication state
Published
Issued date
01/2022
Peer-reviewed
Oui
Volume
15
Number
1
Pages
60-71
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
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.
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.
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.
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.
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. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891).
Keywords
Aged, Coronary Artery Disease/diagnostic imaging, Female, Humans, Magnetic Resonance Spectroscopy, Male, Middle Aged, Predictive Value of Tests, Prognosis, Risk Assessment, Risk Factors, coronary artery disease, ischemia, risk reclassification, stress cardiac magnetic resonance
Pubmed
Web of science
Open Access
Yes
Create date
18/10/2022 9:37
Last modification date
21/03/2023 7:47
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