Key result
Multimodal CMR nomogram improves prediction of incomplete revascularization and 3-year major cardiovascular events over SYNTAX score alone.
Why the study?
Incomplete coronary revascularization in complex MVCAD increases the risk of MACE, yet existing anatomical scoring systems fail to integrate tissue-level myocardial pathology, plaque vulnerability, and circulating inflammatory markers.
Does an integrated multimodal MRI-based prediction nomogram improve prediction of incomplete coronary revascularization and 3-year MACE compared to the SYNTAX score alone in patients with complex multivessel coronary artery disease undergoing PCI or CABG?
Cohort (n=680)
Yes
Does an integrated multimodal MRI-based prediction nomogram improve prediction of incomplete coronary revascularization and 3-year MACE compared to the SYNTAX score alone in patients with complex multivessel coronary artery disease undergoing PCI or CABG?
A multimodal cardiac MRI-based nomogram integrating tissue characterization, plaque morphology, and biomarkers significantly improves the prediction of incomplete revascularization and 3-year MACE compared to the anatomical SYNTAX score alone in complex multivessel CAD.
Answers are grounded in this paper and cite their sources.
May aid risk stratification in multivessel CAD; leaves open prospective validation before clinical adoption.
Background: Incomplete coronary revascularization (ICR) in complex multivessel coronary artery disease (MVCAD) is associated with heightened risks of major adverse cardiovascular events (MACE). Existing anatomical scoring systems often fail to integrate underlying tissue-level myocardial pathology with plaque vulnerability and circulating inflammatory markers. We sought to develop and validate a integrative, multimodal magnetic resonance imaging (MRI)-based prediction nomogram incorporating quantitative multiparametric tissue characterization, plaque morphology, and circulating biomarkers to predict ICR probability and subsequent 3-year MACE. Methods: In this prospective cohort study, 680 patients with complex MVCAD (SYNTAX score ≥ 23) undergoing planned percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were enrolled across two tertiary cardiovascular centers. All participants underwent pre-procedural 3.0-Tesla cardiovascular magnetic resonance (CMR), including quantitative native T1/T2 mapping, extracellular volume fraction (ECV) calculation, diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping, late gadolinium enhancement (LGE) fibrosis quantification, and high-resolution CMR coronary plaque characterization. Multivariable Cox proportional hazards and logistic regression analyses were utilized to construct predictive models. Results: ICR occurred in 218 patients (32.1%). Over a median follow-up of 36 months, MACE occurred in 142 patients (20.9%). Native T1 relaxation times (> 1280 ms), elevated ECV (> 31.5%), reduced ADC values, high-risk plaque characteristics (lipid-rich necrotic core with thin fibrous cap), high-sensitivity C-reactive protein (hs-CRP), and high SYNTAX scores emerged as independent predictors of ICR and 3-year MACE (p < 0.001). The integrated multimodal MRI prediction nomogram demonstrated superior discrimination with a C-index of 0.872 (95% CI: 0.841--0.903) compared to the SYNTAX score alone (C-index 0.714, p < 0.001). Decision curve analysis confirmed significant net clinical benefit across operational threshold probabilities ranging from 10% to 80%. Conclusions: The multimodal MRI-based nomogram provides a precise risk stratification framework that successfully predicts both incomplete revascularization and downstream major adverse cardiac events in patients with complex MVCAD.
No takes yet. Share an insight, caveat, or question.
Camilo Fernández Bravo (2026) conducted a cohort in Complex multivessel coronary artery disease (MVCAD) (n=680). Multimodal MRI-based prediction nomogram (integrating native T1/T2 mapping, ECV, DWI/ADC, LGE fibrosis, plaque characterization, and hs-CRP) vs. SYNTAX score alone was evaluated on Incomplete coronary revascularization (ICR) and 3-year major adverse cardiovascular events (MACE) (C-index 0.872, 95% CI 0.841-0.903, p=<0.001). A multimodal MRI-based prediction nomogram showed superior discrimination for ICR and 3-year major cardiovascular events compared to the SYNTAX score alone.
Synapse has enriched 10 related papers. Consider them for comparative context: