Key result
Inducible ischemia on preoperative stress CMR is linked to ~11-fold higher MACE risk.
Why the study?
Although guidelines recommend preoperative stress testing for patients with risk factors, the appropriate indications for stress perfusion CMR have not been clearly defined.
Does the presence of inducible myocardial ischemia on preoperative stress perfusion CMR predict major adverse cardiovascular events in patients undergoing major noncardiac surgery?
Cohort (n=309)
No
Does the presence of inducible myocardial ischemia on preoperative stress perfusion CMR predict major adverse cardiovascular events in patients undergoing major noncardiac surgery?
Effect estimate: HR 10.72 (95% CI 2.91–39.60)
Absolute Event Rate: 16.9% vs 1.3%
p-value: p=<0.001
Preoperative stress perfusion CMR effectively stratifies risk in patients undergoing major noncardiac surgery, with inducible ischemia strongly predicting perioperative MACE and providing incremental prognostic value over the Revised Cardiac Risk Index.
May inform perioperative risk stratification in noncardiac surgery; leaves open whether ischemia-guided management improves outcomes.
BACKGROUND: Although guidelines recommend preoperative stress testing for patients with risk factors, the appropriate indications for stress perfusion cardiac magnetic resonance (CMR) have not been clearly defined. This study aimed to investigate the value of preoperative stress perfusion CMR in predicting major adverse cardiovascular events (MACE) in patients undergoing major noncardiac surgery. METHODS: This study included 309 patients who underwent CMR within 180 days prior to major noncardiac surgery between 2010 and 2022. Patients were categorized based on the presence or absence of inducible myocardial ischemia. The primary outcome was MACE, defined as a composite of cardiovascular death, myocardial infarction, sustained ventricular arrhythmia, heart failure, or ischemic stroke occurring during the indexed hospitalization for surgery or within 30 days post-discharge. RESULTS: < 0.001). CONCLUSIONS: In this retrospective cohort study, inducible myocardial ischemia detected by stress perfusion CMR in patients undergoing major noncardiac surgery was associated with MACE during hospitalization or within 30 days post-discharge. Larger prospective or multicenter studies are required to validate these findings and ensure generalizability.
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Sukprasert et al. (2025) conducted a cohort in Patients undergoing major noncardiac surgery (n=309). Presence of inducible myocardial ischemia on stress perfusion CMR vs. Absence of inducible myocardial ischemia was evaluated on Major adverse cardiovascular events (MACE) (HR 10.72, 95% CI 2.91–39.60, p=<0.001). Inducible myocardial ischemia detected by preoperative stress perfusion CMR was associated with a significantly higher risk of major adverse cardiovascular events (HR 10.72) compared to patients without ischemia.
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