Key result
Inducible ischaemia predicted MACE in women (HR 4.79; 95% CI 2.17-9.10) and men (HR 3.88; 95% CI 2.33-5.98), while CMR-related revascularization lowered MACE only in patients with LVEF <50%.
Why the study?
To assess the sex-specific, long-term prognostic value of myocardial ischaemia induced by stress CMR and early CMR-related revascularization in consecutive patients.
Do inducible ischaemia on stress CMR and early CMR-related revascularization predict long-term MACE in patients with stable coronary disease irrespective of sex?
Cohort (n=3,664)
Do inducible ischaemia on stress CMR and early CMR-related revascularization predict long-term MACE in patients with stable coronary disease irrespective of sex?
Hazard Ratio: 4.79 (95% CI 2.17–9.1)
p-value: p=<0.001
Inducible ischaemia on stress CMR and early CMR-related revascularization are strong independent predictors of long-term MACE in both men and women with stable coronary disease, with revascularization particularly beneficial in those with LVEF < 50%.
Inducible ischaemia predicts MACE similarly across sexes; extends stress CMR risk stratification evidence while leaving revascularization benefit open in preserved LVEF.
AIMS: To assess the sex-specific, long-term prognostic value of myocardial ischaemia induced by stress cardiovascular magnetic resonance (CMR) and early CMR-related revascularization in consecutive patients from a large registry. METHODS AND RESULTS: Between 2008 and 2010, all consecutive patients referred for stress CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular mortality or recurrent non-fatal myocardial infarction (MI). Early CMR-related revascularization was defined as any revascularization within 90 days after CMR. Among 3664 patients (56.9% male, mean age 69.9 ± 11.8 years), 472 (12.9%) had MACE (163 women and 309 men) after a median follow-up of 8.8 (IQR 6.9-9.5) years. Inducible ischaemia and late gadolinium enhancement (LGE) by CMR were associated with MACE in women and men (all P < 0.001). In multivariable Cox regression, inducible ischaemia, LGE, and CMR-related revascularization were independent predictors of MACE both in women [heart rate (HR) 4.79, 95% confidence interval (CI) 2.17-9.10; HR 1.82, 95% CI 1.22-2.71; HR 0.71, 95% CI 0.54-0.92, respectively; all P < 0.001] and men (HR 3.88, 95% CI 2.33-5.98; HR 1.48, 95% CI 1.16-1.89; HR 0.78, 95% CI 0.65-0.97, respectively; all P < 0.001). The addition of CMR-parameters led to improved model discrimination for MACE (C-statistic 0.61 vs. 0.71; NRI = 0.212; IDI = 0.032) for both women and men. CMR-related revascularization was associated with a lower incidence of MACE in patients with left ventricular ejection fraction (LVEF)<50%. CONCLUSION: Inducible ischaemia and early CMR-related revascularization were good long-term predictors of MACE irrespective of sex. CMR-related revascularization was associated with a lower MACE incidence in the sole sub-set of patients with LVEF < 50%.
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Pezel et al. (2021) conducted a cohort in Stable coronary disease (n=3,664). Inducible ischaemia and early CMR-related revascularization vs. Absence of inducible ischaemia or early revascularization was evaluated on Major adverse cardiovascular events (MACE), defined by cardiovascular mortality or recurrent non-fatal myocardial infarction (HR 4.79, 95% CI 2.17-9.10, p=<0.001). Inducible ischaemia predicted MACE in women (HR 4.79; 95% CI 2.17-9.10) and men (HR 3.88; 95% CI 2.33-5.98), while CMR-related revascularization lowered MACE only in patients with LVEF <50%.
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