Key result
The presence of a stress-induced perfusion defect on ATP stress CMR was independently associated with a significantly higher risk of major adverse cardiovascular events (HR 3.63) compared to patients without a defect.
Why the study?
Adenosine triphosphate is widely used for stress perfusion CMR in the Asia-Pacific region, but prognostic data for patients stressed using ATP were lacking.
Does the presence of an inducible stress perfusion defect on ATP stress CMR predict MACE in patients with suspected obstructive CAD?
Cohort (n=208)
Single-blind
Yes
Does the presence of an inducible stress perfusion defect on ATP stress CMR predict MACE in patients with suspected obstructive CAD?
Hazard Ratio: 3.63 (95% CI 1.879–7.012)
Absolute Event Rate: 44.7% vs 12.9%
p-value: p=<0.001
Inducible perfusion defects on ATP stress CMR are strong independent predictors of major adverse cardiovascular events in patients with suspected obstructive CAD.
ATP stress perfusion defects were associated with higher MACE risk; extends ATP-CMR prognostic data but leaves open prospective validation versus adenosine.
BACKGROUND: Adenosine triphosphate (ATP) has been predominantly used in the Asia-Pacific region for stress perfusion cardiovascular magnetic resonance (CMR). We evaluated the prognosis of patients stressed using ATP, for which there are no current data. METHODS: We performed a retrospective longitudinal study from January 2016 to December 2020 and included 208 subjects with suspected obstructive coronary artery disease (CAD) who underwent ATP stress perfusion CMR. An inducible stress perfusion defect was defined as a subendocardial dark rim involving ≥ 1.5 segments that persisted for ≥ 6 beats during stress but not at rest. The primary outcome measure was a composite of major adverse cardiovascular events (MACE) including (1) cardiac death, (2) nonfatal myocardial infarction, (3) cardiac hospitalization, (4) late coronary revascularization. We compared outcomes in patients with and without perfusion defect using Kaplan-Meier and log rank tests. Significant predictors of MACE were identified using multivariable Cox regression analysis. RESULTS: Median follow-up was 3.3 years. Patients with no stress perfusion defect had a lower incidence of MACE (p < 0.001), including lower cardiac hospitalization (p = 0.004), late coronary revascularization (p = 0.001) and cardiac death (p = 0.003). Significant independent predictors for MACE were stress induced perfusion defect (p < 0.001, hazard ratio [HR] = 3.63), lower left ventricular ejection fractino (LVEF) (p < 0.001, HR = 0.96) and infarct detected by late gadolinium enhancement (LGE) (p = 0.001, HR = 2.92). CONCLUSION: Perfusion defects on ATP stress are predictive of MACE which is driven primarily by cardiac hospitalization, late coronary revascularization and cardiac death. Significant independent predictors of MACE were stress induced perfusion defect, lower LVEF and infarct detected by LGE.
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Ng et al. (2021) conducted a cohort in Suspected or known obstructive coronary artery disease (n=208). Stress-induced perfusion defect on ATP stress CMR vs. No stress-induced perfusion defect was evaluated on Composite of major adverse cardiovascular events (MACE) including cardiac death, nonfatal myocardial infarction, cardiac hospitalization, and late coronary revascularization (HR 3.63, 95% CI 1.879-7.012, p=<0.001). The presence of a stress-induced perfusion defect on ATP stress CMR was independently associated with a significantly higher risk of major adverse cardiovascular events (HR 3.63) compared to patients without a defect.
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