Prognostic Value of Adenosine Cardiac Magnetic Resonance Imaging in Patients Presenting With Chest Pain

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• 作者：Rachid R. Macwar ; MD^a ; ^{rrmacwar@uic.edu} ; Brent A. Williams ; PhD^b ; Jamshid Shirani ; MD^c
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：1 July, 2013
• 年：2013
• 卷：112
• 期：1
• 页码：46-50
• 全文大小：198 K

文摘

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.