Key result
Higher stress MBF linked to ~68% lower MACE risk per 1 mL/g/min increase.
Why the study?
Whether myocardial blood flow can predict major adverse cardiac events during long-term follow-up was unknown.
Does higher stress myocardial blood flow prevent major adverse cardiac events in patients at intermediate to high cardiovascular risk?
Meta-Analysis (n=2,326)
Yes
Does higher stress myocardial blood flow prevent major adverse cardiac events in patients at intermediate to high cardiovascular risk?
Hazard Ratio: 0.32 (95% CI 0.18–0.57)
Quantification of stress myocardial blood flow provides incremental prognostic value for predicting future major adverse cardiac events.
May refine MACE risk stratification in high-risk patients; leaves open whether MBF quantification should guide therapy.
Chronic coronary syndromes involve reduced myocardial blood flow (MBF). MBF is a reliable predictor of outcomes, independent of the presence of significant stenosis. Whether MBF can predict major adverse cardiac events (MACE) during long-term follow-up is unknown. PubMed, Embase, Cochrane, CNKI, and WANFANG were searched for papers published up to January 2021. The exposure was the incremental unit of stress MBF (mL/g/min) or low MBF versus high MBF. The imaging examinations included positron emission tomography/computed tomography and coronary magnetic resonance. The study outcome was the occurrence of MACE during follow-up, summarized as time-to-event hazard ratios (HRs) and 95% confidence intervals (CIs). Six studies (300 MACEs in 2326 patients) were included. Four studies presented stress MBF data by unit increments. The pooled HR showed that an increase in stress MBF by 1 mL/g/min is a protective factor for MACE (HR = 0.32; 95% CI, 0.18-0.57; I2 = 62.9%, Pheterogeneity = 0.044). Two studies reported stress MBF as low/high. The results showed that a high-stress MBF was protective against MACEs (HR = 0.43; 95% CI, 0.24-0.78; I2 = 39.5%, Pheterogeneity = 0.199). Quantification of stress MBF using positron emission tomography/computed tomography and coronary magnetic resonance might have incremental predictive value for future MACEs in a population at intermediate to high cardiovascular risk. The results will require validation in large prospective randomized controlled trials.
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Pan et al. (2022) conducted a meta-analysis in Intermediate to high cardiovascular risk / Chronic coronary syndrome (n=2,326). Higher stress myocardial blood flow vs. Lower stress myocardial blood flow was evaluated on Major adverse cardiac events (MACE) (HR 0.32, 95% CI 0.18-0.57). An increase in stress myocardial blood flow by 1 mL/g/min was associated with a 68% lower risk of major adverse cardiac events (HR 0.32, 95% CI 0.18-0.57).
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