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

Publication ,  Journal Article
Antiochos, P; Ge, Y; Heydari, B; Steel, K; Bingham, S; Abdullah, SM; Mikolich, JR; Arai, AE; Bandettini, WP; Patel, AR; Farzaneh-Far, A ...
Published in: JACC Cardiovasc Imaging
January 2022

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. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891).

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

January 2022

Volume

15

Issue

1

Start / End Page

60 / 71

Location

United States

Related Subject Headings

  • Risk Factors
  • Risk Assessment
  • Prognosis
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Magnetic Resonance Spectroscopy
  • Humans
  • Female
  • Coronary Artery Disease
 

Citation

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Antiochos, P., Ge, Y., Heydari, B., Steel, K., Bingham, S., Abdullah, S. M., … Kwong, R. Y. (2022). Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease. JACC Cardiovasc Imaging, 15(1), 60–71. https://doi.org/10.1016/j.jcmg.2021.06.025
Antiochos, Panagiotis, Yin Ge, Bobak Heydari, Kevin Steel, Scott Bingham, Shuaib M. Abdullah, J Ronald Mikolich, et al. “Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease.JACC Cardiovasc Imaging 15, no. 1 (January 2022): 60–71. https://doi.org/10.1016/j.jcmg.2021.06.025.
Antiochos P, Ge Y, Heydari B, Steel K, Bingham S, Abdullah SM, et al. Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease. JACC Cardiovasc Imaging. 2022 Jan;15(1):60–71.
Antiochos, Panagiotis, et al. “Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease.JACC Cardiovasc Imaging, vol. 15, no. 1, Jan. 2022, pp. 60–71. Pubmed, doi:10.1016/j.jcmg.2021.06.025.
Antiochos P, Ge Y, Heydari B, Steel K, Bingham S, Abdullah SM, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease. JACC Cardiovasc Imaging. 2022 Jan;15(1):60–71.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

January 2022

Volume

15

Issue

1

Start / End Page

60 / 71

Location

United States

Related Subject Headings

  • Risk Factors
  • Risk Assessment
  • Prognosis
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Magnetic Resonance Spectroscopy
  • Humans
  • Female
  • Coronary Artery Disease