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Stress Perfusion CMR Imaging-Guided Management and Prognosis in Patients With Suspected Coronary Heart Disease
Antonin Trimaille1,2,3,4,5, Philippe Garot1, Solenn Toupin3
1Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, Massy, France (A.T., P.G., F.S., T.H., S.D., S.C., T.U., M.A., A.N., E.G., J.G., T.P.).
Insights
Stress cardiac magnetic resonance (CMR) guided revascularization significantly lowers death rates in chronic coronary syndrome patients. Combining ischemia and late gadolinium enhancement (LGE) assessments improves patient selection for this strategy.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Chronic coronary syndrome (CCS) management requires identifying patients who benefit from revascularization.
- Data on stress cardiac magnetic resonance (CMR) guiding revascularization is limited.
- Assessing the long-term prognostic impact of stress CMR-guided revascularization on all-cause death is crucial.
Purpose of the Study:
- To evaluate the effectiveness of stress CMR-guided coronary revascularization in predicting long-term outcomes.
- To determine if stress CMR can identify patients with CCS who benefit most from revascularization.
- To assess the association between stress CMR findings and all-cause mortality.
Main Methods:
- An observational study included consecutive CCS patients undergoing stress CMR across three French centers.
- CMR-guided revascularization was defined as procedures within 90 days post-CMR.
- The primary endpoint was all-cause death, with analysis including propensity-matched cohorts.
Main Results:
- Over 50,000 patients were followed for a median of 7.2 years; 7.2% died.
- Ischemia and late gadolinium enhancement (LGE) without viability independently predicted death.
- Stress CMR-guided revascularization was an independent predictor of improved survival (aHR 0.30) and this benefit persisted in matched cohorts (aHR 0.37).
Conclusions:
- Stress CMR-guided revascularization is associated with reduced mortality in CCS patients.
- The combination of inducible ischemia and LGE assessment aids in selecting appropriate candidates for revascularization.
- This strategy offers prognostic value in managing chronic coronary syndrome.
Background:
Identifying patients with chronic coronary syndrome who will benefit most from a coronary revascularization strategy is essential. Data on the performance of stress cardiac magnetic resonance (CMR) to guide revascularization are limited. To assess the long-term prognostic impact of stress CMR-guided revascularization strategy to predict all-cause death.
Methods:
We conducted an observational study including all consecutive patients who underwent stress CMR for suspected or known chronic coronary syndrome in 3 centers in France. CMR-guided coronary revascularization was defined as any revascularization performed within 90 days following stress CMR. The primary outcome was all-cause death.
Results:
A total of 50 701 patients were included (mean age, 64±12 years; 68.5% men). After a median follow-up of 7.2 years (interquartile range, 3.0-11.0), 3665 (7.2%) patients died. Among the 7396 patients with ischemia, 6523 (88%) underwent revascularization. Ischemia and late gadolinium enhancement (LGE) without viability were independent predictors of death (adjusted hazard ratio, 3.67 [99.5% CI, 3.15-4.27] and adjusted hazard ratio, 1.26 [99.5% CI, 1.10-1.44], respectively; P<0.001 for both). CMR-guided revascularization was an independent predictor of improved survival in the overall population (adjusted hazard ratio, 0.30 [99.5% CI, 0.25-0.36]). In a 1:1 propensity-matched cohort of 1700 patients, CMR-guided revascularization remained independently associated with a lower incidence of death (adjusted hazard ratio, 0.37 [99.5% CI, 0.28-0.50]; P<0.001). This beneficial effect was observed in patients without LGE or with LGE and viability (P<0.001 for both), but not in those with LGE without viability (P=0.23).
Conclusions:
In this registry of consecutive patients with chronic coronary syndrome from 3 centers, stress CMR-guided revascularization was associated with a lower rate of death. The combined assessment of inducible myocardial ischemia and LGE may help to select patients most suitable for revascularization.
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