Prognostic value of adenosine cardiac magnetic resonance imaging in patients presenting with chest pain

Rachid R Macwar, Brent A Williams, Jamshid Shirani
American Journal of Cardiology 2013 July 1, 112 (1): 46-50
Adenosine cardiac magnetic resonance imaging (AS-CMR) has emerged as an alternative to other stress tests for identifying coronary artery disease. From January 1, 2002 to January 1, 2009, 564 consecutive patients underwent AS-CMR for evaluation of chest pain. The clinical characteristics, AS-CMR findings, and outcomes were evaluated by retrospective chart review and telephone interview. The median follow-up was 51 months. Major adverse cardiac events (MACE) were defined as cardiac death, nonfatal myocardial infarction, and revascularization with percutaneous coronary intervention or bypass surgery. The AS-CMR findings were normal in 264, ischemic in 201, and scar in 240 patients. No cardiac death occurred in the normal AS-CMR group. Among the ischemic and scar groups, 7.2% and 8.3% experienced an event, respectively. On univariate analysis, ischemia (hazard ratio 5.3, 95% confidence interval 2.5 to 11.5, p <0.001) and the presence of scar (hazard ratio 5.7, 95% confidence interval 2.6 to 12.4, p <0.001) were independent predictors of all cardiac events. Multivariate Cox regression analysis for MACE identified the presence of ischemia (hazard ratio 2.8, 95% confidence interval 1.2 to 6.2, p = 0.01) and scarring (hazard ratio 2.9, 95% confidence interval 1.3 to 6.6, p = 0.01) as the strongest independent factors. The annual event rate for hard events was 0% in the normal, 1.7% in the scar, and 1.5% in the ischemia group. For the MACE end points, the rate was 0.5% in the normal, 2.4% in the scar, and 2.6% in the ischemia group. In conclusion, in the present, single-center cohort with chest pain, normal AS-CMR findings conferred very low risk (<1% annually) of MACE. However, the findings of ischemia or scar were a significant and independent predictor of hard events and MACE.

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