Abstract 3775: Adenosine Perfusion Cardiac Magnetic Resonance Imaging Predicts Adverse Outcome in Chest Pain Patients suspected of Coronary Artery Disease
Background: Adenosine cardiac magnetic resonance imaging (CMR) has emerged as an alternative to other stress test modalities for identifying clinically significant coronary artery disease. Data on the prognostic value of qualitatively analyzed adenosine CMR remains limited.
Methods: From 1/1/2002 to 10/30/2005, 284 pts (mean age 60.1±13.1 years; Framingham Risk Score (FRS) mean 9.4±7.8) underwent qualitative CMR for the evaluation of chest pain. The clinical characteristics, CMR findings and outcomes of all 284 patients were evaluated by retrospective chart review and telephone interviews. Follow-up in all pts ranged from 1.2 to 51.4 (mean 26.1) months. All pts received standard medical care. Major adverse cardiac endpoints (MACE) were defined as cardiac death and nonfatal myocardial infarction. Kaplan-Meier survival curves were constructed to evaluate the prognostic significance of CMR.
Results: CMR was normal in 169, ischemic in 47, scarred in 21 and mixed in 47. A total of 8 MACE occurred; only 1 with normal CMR. Pts with events were older (age 70 vs 60 yrs, p=0.0316) but had similar gender and FRS compared with those without events. Event-free survival at 3 yrs was 98.2% with a normal CMR; 96.3% with ischemia /scar in one coronary territory, and 81.1% with ischemia/scar in multiple coronary territories (p=0.0002). Event-free survival at 3 yrs with ischemia alone was 97.8%, scar alone was 87.9%, and ischemia with scar was 85.7% (p=0.005)
Conclusions: In this single center cohort of pts presenting with chest pain, a normal adenosine CMR conferred very low risk (<1% per year) of MACE. The extent of abnormality and the presence of scar predicted cardiac events.