Magnetocardiography for Exploratory Risk Stratification in Patients With Three-Vessel Coronary Artery Disease: A
Ziyu An1, Shipan Wang2, Min Zhang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China, ccmu.edu.cn.
Insights
Magnetocardiography (MCG) shows promise in predicting major adverse cardiovascular and cerebrovascular events (MACCE) in three-vessel coronary artery disease (3V-CAD) patients post-revascularization, offering complementary electrophysiological insights beyond anatomical scores.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Patients with three-vessel coronary artery disease (3V-CAD) exhibit varied risks for major adverse cardiovascular and cerebrovascular events (MACCE) following revascularization.
- Magnetocardiography (MCG), a non-contact, radiation-free imaging method, may detect electrophysiological abnormalities missed by traditional anatomical risk assessments.
Purpose of the Study:
- To investigate the exploratory prognostic value of MCG-derived parameters in patients diagnosed with 3V-CAD.
Main Methods:
- A single-center prospective cohort study involving 544 patients with 3V-CAD who underwent coronary revascularization.
- Pre-revascularization MCG recordings were acquired using a 36-channel optically pumped magnetometer system.
- Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as the primary endpoint, including cardiac death, stroke, myocardial infarction, or unplanned revascularization. Cox regression models incorporated clinical variables, SYNTAX score, and an MCG composite variable, with performance evaluated via discrimination, calibration, decision curve analysis, and bootstrap validation.
Main Results:
- Over a median follow-up of 725 days, 37 patients (6.8%) experienced MACCE.
- Both the SYNTAX score and the MCG composite variable were independently associated with MACCE after adjusting for clinical variables and the other score.
- While adding MCG to a model with clinical variables and SYNTAX score increased discrimination (C-index from 0.682 to 0.727), this improvement was not statistically significant (p=0.17). Bootstrap validation yielded an optimism-corrected C-index of 0.672.
Conclusions:
- MCG-derived parameters demonstrated an association with MACCE, suggesting potential for complementary electrophysiological information in risk stratification for 3V-CAD patients post-revascularization.
- Larger multicenter studies with external validation are necessary to confirm the supplementary prognostic utility of MCG.
Background And Aims:
Patients with three-vessel coronary artery disease (3V-CAD) remain at heterogeneous risk for major adverse cardiovascular and cerebrovascular events (MACCE) after revascularization. Magnetocardiography (MCG) is a noncontact and radiation-free technique that may capture electrophysiological abnormalities not reflected by anatomical risk scores. This study evaluated the exploratory prognostic value of MCG-derived parameters in patients with 3V-CAD.
Methods:
This single-center prospective cohort study included 544 patients with 3V-CAD who underwent coronary revascularization. MCG recordings were obtained before revascularization using a 36-channel optically pumped magnetometer-based system. The primary endpoint was MACCE, defined as cardiac death, stroke, myocardial infarction, or unplanned revascularization. Cox regression models were constructed using clinical variables, SYNTAX score, and an MCG composite variable. Model performance was assessed using discrimination, calibration, decision curve analysis, and bootstrap internal validation.
Results:
During a median follow-up of 725 days, 37 patients (6.8%) experienced MACCE. The SYNTAX score was independently associated with MACCE after adjustment for clinical variables and MCG score (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.04-1.12; p < 0.001). The MCG composite variable was also associated with MACCE after adjustment for clinical variables and SYNTAX score (HR, 2.74; 95% CI, 1.57-4.79; p < 0.001). Model discrimination increased from 0.596 for clinical variables alone to 0.682 after adding SYNTAX score and to 0.727 after adding MCG. However, the improvement from the clinical + SYNTAX model to the MCG-added model was not statistically significant (p = 0.17). Bootstrap validation showed an optimism-corrected C-index of 0.672.
Conclusion:
MCG-derived parameters were associated with MACCE and may provide complementary electrophysiological information for exploratory risk stratification in patients with 3V-CAD after revascularization. Larger multicenter studies with external validation are needed to confirm its complementary prognostic value.
Trial Registration:
Chinese Clinical Trial Registry identifier: ChiCTR2200066942.
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