Prognostic Value of Coronary Magnetic Resonance Angiography for Prediction of Cardiac Events in Patients With Suspected Coronary Artery Disease

Study Questions:

Are coronary magnetic resonance angiography (MRA) findings associated with risk of adverse events?

Methods:

This retrospective study examined 207 patients with suspected coronary artery disease (CAD) undergoing noncontrast coronary MRA, and evaluated the relationship between significant (≥50% diameter) stenosis by MRA and adverse events, including severe cardiac events (cardiac death, myocardial infarction, or unstable angina) and total cardiac events (severe events or revascularization >90 days after MRA). The study excluded patients with known CAD (n = 52) and those lost to follow-up (n = 19). All visible arterial segments were evaluated regardless of image quality in an intent-to-diagnose design.

Results:

Mean age was 68 ± 10 years, 62% were men, and 41% had significant stenosis by MRA. All three coronary arteries were visualized in all subjects. Median follow-up was 25 months, with five severe cardiac events and 10 total cardiac events in patients with significant stenosis, and one event in patients without significant stenosis (late revascularization). Patients with (vs. without) significant stenosis were observed to have increased severe cardiac events (6.0% vs. 0%, p = 0.003) and total cardiac events (11.9% vs. 0.8%, p < 0.001). The presence of significant stenosis was associated with an increased adjusted risk of total cardiac events (hazard ratio, 18.0; 95% confidence interval, 2.3-141.7; p = 0.006).

Conclusions:

The authors concluded that presence of significant stenosis by coronary MRA is associated with an increased risk of intermediate-term cardiac events.

Perspective:

Coronary MRA has been considered a promising technique to evaluate the presence of stenosis for many years, particularly as it can be done without contrast, and as it utilizes no ionizing radiation. Nevertheless, its clinical use has been constrained due to its limited spatial resolution (which particularly limits imaging of more distal arterial segments), high acquisition times, and technical challenges that limit the routine and straightforward performance of high-quality coronary imaging. While these challenges still need to be addressed, this retrospective single-center study establishes that significant stenosis defined by coronary MRA may have prognostic implications. These findings are intriguing, but future prospective multicenter studies are needed to more definitively evaluate the prognostic performance of coronary MRA.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Incidence, Prognosis, Risk, Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Coronary Stenosis, Coronary Angiography, Cardiology, Magnetic Resonance Angiography


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