Abstract 11215: Adenosine Perfusion Cardiac Magnetic Resonance Imaging Provides Excellent Risk Stratification and Long-term Prognostic Value in Patients With Stable Coronary Artery Disease

Abstract

Background: Recently, it has been shown that cardiac magnetic resonance imaging (CMR) provides good short-term prognosis in patients with stable coronary heart disease (CAD). Data concerning long-term prognostic information, especially of major clinical endpoints like cardiac death or myocardial infarction is limited. Furthermore, most of the studies available, on which the given information is based, only included specific subsets of patients and defined rather soft clinical endpoints. We assessed the hypothesis that CMR myocardial perfusion imaging is able to provide incremental prognostic value regarding the prediction of major cardiovascular events in a large, consecutive and thereby unselected population of patients presenting with stable angina pectoris.

Methods: From 2003 to 2007 consecutive patients with stable angina pectoris who underwent adenosine perfusion CMR were enrolled unless they exhibited the predefined exclusion criteria. Myocardial perfusion imaging by adenosine-stress and late gadolinium enhancement were assessed in a 1.5 T whole-body CMR-scanner. Follow-up information concerning the combined endpoint cardiac death, non-fatal myocardial infarction and stroke was gotten from the patient, the general practitioner or the treating hospital, respectively.

Results: In our study, 1,229 consecutive patients were enrolled. Mean follow-up period was 4.2 ± 2.1 years. During this time 88 primary endpoints occurred. In patients with reversible perfusion deficit significantly more cardiac deaths (p<0.0001) and non-fatal myocardial infarction (p=0.001) was observed than in the control group. In a multivariate analysis, reversible perfusion deficit was the strongest independent predictor for an event with a 3-fold increased risk (Hazard ratio 2.99). Moreover, the absence of a perfusion deficit has shown to exhibit a high negative predictive value.

Conclusion: Adenosine perfusion CMR provides excellent risk stratification and long-term prognostic value in patients with stable CAD. Presence of myocardial perfusion deficit is an incremental prognostic risk factor over other risk factors.