Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Ramsay Santé, Massy, France (T.P., T.U., P.G., T.H., F.S., S.C., J.G.).
Division of Cardiology, Johns Hopkins University, Baltimore, MD (T.P.).
Circ Cardiovasc Imaging. 2021 Oct;14(10):e012789. doi: 10.1161/CIRCIMAGING.121.012789. Epub 2021 Oct 6.
Although the benefit of coronary revascularization in patients with stable coronary disease is debated, data assessing the potential interest of stress cardiovascular magnetic resonance (CMR) to guide coronary revascularization are limited. We aimed to assess the long-term prognostic value of stress CMR-related coronary revascularization in consecutive patients from a large registry.
Between 2008 and 2018, a retrospective cohort study with a median follow-up of 6.0 years (interquartile range, 5.0-8.0) included all consecutive patients referred for stress CMR. CMR-related coronary revascularization was defined by any coronary revascularization performed within 90 days after CMR. The primary outcome was all-cause death based on the National Death Registry.
Among the 31 762 consecutive patients (mean age 63.7±12.1 years and 65.7% males), 2679 (8.4%) died at 206 453 patient-years of follow-up. Inducible ischemia and late gadolinium enhancement by CMR were associated with death (both <0.001). In multivariable Cox regression, inducible ischemia and late gadolinium enhancement were independent predictors of death (hazard ratio, 1.61 [99.5% CI, 1.41-1.84]; hazard ratio, 1.62 [99.5% CI, 1.41-1.86], respectively; <0.001). In the overall population, CMR-related coronary revascularization was an independent predictor of greater survival (hazard ratio, 0.58 [99.5% CI, 0.46-0.74]; <0.001). In 1680, 1:1 matched patients using a limited number of variables (840 revascularized, 840 nonrevascularized), CMR-related revascularization was associated with a lower incidence of death in patients with severe inducible ischemia (≥6 segments, <0.001) but showed no benefit in patients with mild or moderate ischemia (<6 segments, =0.109). Using multivariable analysis in the propensity-matched population, CMR-related revascularization remained an independent predictor of a lower incidence of all-cause mortality (hazard ratio, 0.66 [99.5% CI, 0.54-0.80], <0.001).
In this large observational series of consecutive patients, stress perfusion CMR had important incremental long-term prognostic value to predict death over traditional risk factors. CMR-related revascularization was associated with a lower incidence of death in patients with severe ischemia.
虽然稳定型冠心病患者行冠状动脉血运重建术的获益尚存争议，但评估应激心血管磁共振（CMR）指导冠状动脉血运重建潜在意义的数据有限。我们旨在评估大型注册研究中连续患者行应激 CMR 相关冠状动脉血运重建的长期预后价值。
2008 年至 2018 年，我们进行了一项回顾性队列研究，中位随访时间为 6.0 年（四分位距，5.0-8.0），纳入所有因应激 CMR 而转诊的连续患者。CMR 相关冠状动脉血运重建定义为 CMR 后 90 天内进行的任何冠状动脉血运重建。主要结局是基于国家死亡登记处的全因死亡。
在 31762 例连续患者（平均年龄 63.7±12.1 岁，65.7%为男性）中，206453 患者-年随访期间有 2679 例（8.4%）死亡。CMR 诱导性缺血和晚期钆增强与死亡相关（均<0.001）。多变量 Cox 回归分析显示，诱导性缺血和晚期钆增强是死亡的独立预测因素（危险比，1.61[99.5%CI，1.41-1.84]；危险比，1.62[99.5%CI，1.41-1.86]；均<0.001）。在总体人群中，CMR 相关冠状动脉血运重建是生存的独立预测因素（危险比，0.58[99.5%CI，0.46-0.74]；<0.001）。在使用有限数量变量（840 例血运重建，840 例非血运重建）进行 1:1 匹配的 1680 例患者中，CMR 相关血运重建与严重诱导性缺血（≥6 节段）患者的死亡率降低相关（<0.001），但在轻度或中度缺血（<6 节段）患者中未见获益（=0.109）。在倾向匹配人群的多变量分析中，CMR 相关血运重建仍然是全因死亡率降低的独立预测因素（危险比，0.66[99.5%CI，0.54-0.80]；<0.001）。
在这项大型连续患者观察性系列研究中，应激灌注 CMR 在预测死亡方面具有重要的长期预后价值，可提供传统危险因素之外的额外信息。CMR 相关血运重建与严重缺血患者的死亡率降低相关。
