Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.H., M.K., F.S., S.C., T.U., P.G., J.G.).
Division of Cardiology, Johns Hopkins University, Baltimore, MD (T.P.).
Circ Cardiovasc Imaging. 2021 Jun;14(6):e012374. doi: 10.1161/CIRCIMAGING.120.012374. Epub 2021 Jun 15.
Recurrence of cardiovascular events remains a substantial cause of mortality and morbidity among patients with previous coronary revascularization. The aim was to assess the prognostic value of stress cardiovascular magnetic resonance (CMR) parameters in patients with history of percutaneous coronary intervention.
Between 2011 and 2014, consecutive patients with history of percutaneous coronary intervention referred for stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACEs), defined by cardiovascular death or nonfatal myocardial infarction. Patients with prior coronary artery bypass graft were excluded. Univariable and multivariable Cox regressions were performed to determine the prognostic value of each parameter.
Of 1762 patients who completed the CMR protocol, 1624 patients (81.7% male, mean age 67.9±10.4 years) completed the follow-up (median [interquartile range], 6.7 [5.6-7.3] years); 244 experienced a MACE (15.0%). Stress CMR was well tolerated. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement were significantly associated with the occurrence of MACE (hazard ratio, 2.70 [95% CI, 2.11-3.46], <0.001; and hazard ratio: 1.52 [95% CI, 1.16-1.99], =0.002; respectively). In multivariable Cox regression, inducible ischemia and late gadolinium enhancement were independent predictors of a higher incidence of MACE (hazard ratio, 2.79 [95% CI, 2.16-3.60]; <0.001 and hazard ratio, 1.41 [95% CI, 1.04-1.90], =0.032; respectively).
Inducible ischemia and late gadolinium enhancement assessed by stress CMR were independently associated with MACE in patients with history of percutaneous coronary intervention.
在既往接受过冠状动脉血运重建的患者中，心血管事件复发仍然是导致死亡率和发病率居高不下的主要原因。本研究旨在评估有经皮冠状动脉介入治疗（PCI）史患者的应激心血管磁共振（CMR）参数的预后价值。
2011 年至 2014 年，连续入组因疑似缺血行应激灌注 CMR 检查的既往接受过 PCI 的患者，主要心血管不良事件（MACE）的定义为心血管死亡或非致死性心肌梗死。排除既往接受过冠状动脉旁路移植术的患者。采用单变量和多变量 Cox 回归分析确定每个参数的预后价值。
1762 例完成 CMR 检查的患者中，1624 例（81.7%为男性，平均年龄 67.9±10.4 岁）完成了随访（中位数[四分位间距]，6.7[5.6-7.3]年）；244 例发生 MACE（15.0%）。应激 CMR 检查耐受性良好。Kaplan-Meier 分析显示，可诱导性缺血和晚期钆增强与 MACE 的发生显著相关（危险比，2.70[95%可信区间，2.11-3.46]，<0.001；和危险比：1.52[95%可信区间，1.16-1.99]，=0.002）。多变量 Cox 回归分析显示，可诱导性缺血和晚期钆增强是 MACE 发生率较高的独立预测因素（危险比，2.79[95%可信区间，2.16-3.60]；<0.001 和危险比，1.41[95%可信区间，1.04-1.90]，=0.032）。
应激 CMR 评估的可诱导性缺血和晚期钆增强与既往接受过 PCI 的患者的 MACE 独立相关。
