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Cardiac magnetic resonance stress perfusion imaging for evaluation of patients with chest pain

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Item Type:Article
Title:Cardiac magnetic resonance stress perfusion imaging for evaluation of patients with chest pain
Creators Name:Kwong, R.Y. and Ge, Y. and Steel, K. and Bingham, S. and Abdullah, S. and Fujikura, K. and Wang, W. and Pandya, A. and Chen, Y.Y. and Mikolich, J.R. and Boland, S. and Arai, A.E. and Bandettini, W.P. and Shanbhag, S.M. and Patel, A.R. and Narang, A. and Farzaneh-Far, A. and Romer, B. and Heitner, J.F. and Ho, J.Y. and Singh, J. and Shenoy, C. and Hughes, A. and Leung, S.W. and Marji, M. and Gonzalez, J.A. and Mehta, S. and Shah, D.J. and Debs, D. and Raman, S.V. and Guha, A. and Ferrari, V.A. and Schulz-Menger, J. and Hachamovitch, R. and Stuber, M. and Simonetti, O.P.
Abstract:Background: Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies. Objectives: 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. Methods: 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. Results: 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 (<1%) and coronary revascularization (1% to 3%), across all years of study follow-up. In contrast, patients with ischemia+/LGE+ experienced a >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. Conclusions: 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).
Keywords:Cost of Care, Prognosis, Stress Cardiac Magnetic Resonance Imaging
Source:Journal of the American College of Cardiology
Page Range:1741-1755
Date:8 October 2019
Official Publication:https://doi.org/10.1016/j.jacc.2019.07.074
PubMed:View item in PubMed

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