Title

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

Document Type

Conference Proceeding

Publication Title

American Journal of Cardiology

Abstract

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. © 2013 Elsevier Inc. All rights reserved.

First Page

46

Last Page

50

DOI

10.1016/j.amjcard.2013.02.054

Publication Date

7-1-2013

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