Stress Cardiac MRI, a reliable method to assess prognosis in CAD patients: JACC

CMR-assessed ischemia is strongly associated with MI/CV death and reclassified patient risk beyond CV risk factors, particularly in those considered to be at intermediate risk.

USA: Stress testing is the hallmark of noninvasive tests to identify possible chances of Coronary Artery Disease(CAD). Stress cardiac magnetic resonance (CMR) imaging has been reported in numerous studies to be valuable and cost-effective in CAD diagnosis and risk stratification of cardiac events. A new study by Panagiotis Antiochos and their team evaluated whether CMR is a reliable method of diagnosis. The study has been e-published in the journal JACC: Cardiovascular Imaging.

The objective of the study was 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.

The researchers identified consecutive patients from the Stress Perfusion Imaging in the United States (SPINS) registry, with documented CAD who were referred to stress CMR for evaluation of myocardial ischemia. The primary outcome was found to be non-fatal 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.

The researchers found that out of 755 patients (age 64 ± 11 years, 64% male), and they 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) and MACE (HR: 2.24). In a multivariate model that was adjusted for CV risk factors, it was observed that ischemia maintained strong association with MI/CV death (HR: 1.84) and MACE (HR: 1.77) 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.

The researchers concluded that "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."

For further information:

Panagiotis Antiochos, Yin Ge, Bobak Heydari, Kevin Steel, Scott Bingham, Shuaib M. Abdullah, J. Ronald Mikolich, Andrew E. Arai, W. Patricia Bandettini, Amit R. Patel, Afshin Farzaneh-Far, John F. Heitner, Chetan Shenoy, Steve W. Leung et al "Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease" Journal American College Cardiology Img. Aug 17, 2021DOI: 10.1016/j.jcmg.2021.06.025.