Stress CMR imaging in suspected CAD reclassifies risk status for many patients

  • Antiochos P & al.
  • JAMA Cardiol
  • 29 Jul 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Cardiac magnetic resonance (CMR) imaging of patients with suspected myocardial ischemia but no coronary artery disease (CAD) history reclassifies risk for many patients.

Why this matters

  • In these patients, stress CMR imaging may add prognostic value for myocardial infarction (MI) and cardiovascular death, in addition to supporting decision-making with adjusted risk stratification.

Key results

  • Median follow-up, 5.4 (interquartile range, 4.6-6.9) years.
  • 3.9% had cardiovascular death/nonfatal MI.
  • 11.2% had a major adverse cardiac event (MACE).
  • 13.4% of 1698 were positive for ischemia on stress CMR imaging.
  • Adding imaging parameters to baseline risk models yielded better classification of these patients.
    • Stress CMR imaging reclassified 33.5% (568 of 1698) into a more apt risk group for cardiovascular death/nonfatal MI, especially reclassification from intermediate risk (60.3%) to low (52.4%) or high risk (7.9%).
    • Stress CMR imaging also reclassified 59.9% of patients from intermediate risk for MACE to higher (48.7%) or lower (11.2%) risk.

Study design

  • Retrospective, multicenter cohort study at 13 US centers.
  • Funding: Siemens Healthineers; Bayer AG.

Limitations

  • Retrospective.
  • Some key data on wall motion abnormalities not available.