Key result
Inducible ischemia on stress CMR predicts ~236% higher MACE risk in prediabetic patients with suspected CAD.
Why the study?
Stress perfusion cardiac magnetic resonance is accurate for evaluating suspected coronary artery disease, but its prognostic value in prediabetic patients is uncertain.
Does the presence of inducible ischemia on adenosine stress perfusion CMR predict major adverse cardiovascular events in prediabetic patients with suspected CAD?
Cohort (n=452)
Does the presence of inducible ischemia on adenosine stress perfusion CMR predict major adverse cardiovascular events in prediabetic patients with suspected CAD?
Answers are grounded in this paper and cite their sources.
Stress perfusion CMR, specifically the presence of inducible ischemia and late gadolinium enhancement, provides significant independent prognostic value for predicting MACE in prediabetic patients with suspected CAD.
BACKGROUND: Stress perfusion cardiac magnetic resonance (CMR) is an accurate and comprehensive modality for evaluating patients with suspected coronary artery disease (CAD), but its prognostic value in prediabetic patients is uncertain. METHODS: This retrospective study included 452 consecutive prediabetic patients without prior diagnoses of CAD who underwent adenosine stress perfusion CMR. The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiovascular death, nonfatal myocardial infarction (MI), hospitalization for heart failure, ischemic stroke, and late coronary revascularization (>90 days post-CMR). The secondary endpoint was a composite of cardiovascular death, nonfatal MI, and hospitalization for heart failure. RESULTS: The mean age was 68±11 years (49% male). Over a median follow-up time of 8.1 (IQR 5.7, 10.4) years, 55 patients experienced MACE, and 24 met the secondary endpoint. Patients with inducible ischemia had significantly greater annualized event rates for MACE (5.7% vs. 0.7%, p<0.001) and for the secondary endpoint (2.0% vs. 0.3%, p<0.001) than those without ischemia. Multivariable analysis revealed inducible ischemia as a consistent predictor for MACE (HR 3.36, 95%CI 1.90-5.94, p<0.001) and for the secondary endpoint (HR 2.89, 95%CI 1.22-6.80, p = 0.01). Late gadolinium enhancement (LGE) was an independent predictor of the secondary endpoint (HR 3.56, 95%CI 1.25-10.13; p = 0.02). Incorporating inducible ischemia and LGE data significantly improved the model's ability to discriminate MACE risk (C-statistic increase from 0.77 to 0.83; net reclassification improvement 0.42; integrated discrimination improvement 0.05). CONCLUSION: Stress perfusion CMR offers substantial independent prognostic value and effectively aids in reclassifying cardiovascular risk among prediabetic patients with suspected CAD.
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Leungratanamart et al. (2024) conducted a cohort in Prediabetes and suspected coronary artery disease (n=452). Inducible ischemia on stress perfusion CMR vs. No inducible ischemia was evaluated on Major adverse cardiovascular events (MACE), defined as cardiovascular death, nonfatal MI, hospitalization for heart failure, ischemic stroke, and late coronary revascularization (HR 3.36, 95% CI 1.90-5.94, p=<0.001). Inducible ischemia on stress perfusion CMR was a strong predictor of MACE in prediabetic patients with suspected CAD (annualized event rate 5.7% vs 0.7%; HR 3.36, 95% CI 1.90-5.94, p<0.001).
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