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Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain

2019; Elsevier BV; Volume: 74; Issue: 14 Linguagem: Inglês

10.1016/j.jacc.2019.07.074

1558-3597

Raymond Y. Kwong, Yin Ge, Kevin Steel, Scott E. Bingham, Shuaib Abdullah, Kana Fujikura, Wei Wang, Ankur Pandya, Yi-Yun Chen, J. Ronald Mikolich, Sebastian Boland, Andrew E. Arai, W. Patricia Bandettini, Sujata M. Shanbhag, Amit R. Patel, Akhil Narang, Afshin Farzaneh‐Far, Benjamin Romer, John F. Heitner, Jean Ho, Jaspal Singh, Chetan Shenoy, Andrew Hughes, Steve Leung, Meera Marji, Jorge A. González, Sandeep Mehta, Dipan J. Shah, Dany Debs, Subha V. Raman, Avirup Guha, Victor A. Ferrari, Jeanette Schulz‐Menger, Rory Hachamovitch, Matthias Stuber, Orlando P. Simonetti,

Medical Imaging Techniques and Applications

Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies.This study sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the United States.In this retrospective study, consecutive patients from 13 centers across 11 states who presented with a chest pain syndrome and were referred for stress CMR were followed for a target period of 4 years. The authors associated CMR findings with a primary outcome of cardiovascular death or nonfatal myocardial infarction using competing risk-adjusted regression models and downstream costs of ischemia testing using published Medicare national payment rates.In this study, 2,349 patients (63 ± 11 years of age, 47% female) were followed for a median of 5.4 years. Patients with no ischemia or late gadolinium enhancement (LGE) by CMR, observed in 1,583 patients (67%), experienced low annualized rates of primary outcome ( 4-fold higher annual primary outcome rate and a >10-fold higher rate of coronary revascularization during the first year after CMR. Patients with ischemia and LGE both negative had low average annual cost spent on ischemia testing across all years of follow-up, and this pattern was similar across the 4 practice environments of the participating centers.In a multicenter U.S. cohort with stable chest pain syndromes, stress CMR performed at experienced centers offers effective cardiac prognostication. Patients without CMR ischemia or LGE experienced a low incidence of cardiac events, little need for coronary revascularization, and low spending on subsequent ischemia testing. (Stress CMR Perfusion Imaging in the United States [SPINS]: A Society for Cardiovascular Resonance Registry Study; NCT03192891).