Large Registries

1394767 - Prognosis by Myocardial Patterns of Ischemia and Infarction from 4,581 Stable Chest Pain Patients from the multicenter SCMR registry Stress CMR Perfusion Imaging in the United States (SPINS) Study

Friday, January 27, 2023

10:00 AM – 10:10 AM

Location: Silver Pearl 2

Presenting Author(s)

Raymond Y. Kwong, MD, MPH, FSCMR

Director of Cardiac Magnetic Resonance Imaging
Brigham and Women's Hospital
Boston, Massachusetts, United States

Primary Author(s)

Raymond Y. Kwong, MD, MPH, FSCMR

Director of Cardiac Magnetic Resonance Imaging
Brigham and Women's Hospital
Boston, Massachusetts, United States

Co-Author(s)

SI

Sabeeh Islam, MBBS

Research Fellow
Brigham and Women's Hospital, United States
PA

Panagiotis Antiochos, MD

Cardiologist
University Hospital of Lausanne (CHUV), Switzerland
Bobby Heydari, MD

Associate Professor
University of Calgary
Calgary, Alberta, Canada
Yin Ge, MD

Cardiologist
University of Toronto
Cambridge, Massachusetts, Canada
Kevin Steel, MD

Cardiologist
St Joseph Medical Center
Bellingham, Washington, United States
SB

Scott E. Bingham, MD

Cardiologist
Revere Health
Provo, Utah, United States
JM

J. Ronald Mikolich, MD

Professor
Northeast Ohio Medical University
Sharon, Pennsylvania, United States
Andrew E. E. Arai, MD

Cardiologist
NIH
Kensington, Maryland, United States
WB

W. Patricia Bandettini, MD

Cardiologist
NIH, Maryland, United States
Sujata Shanbhag, MD

Cardiologist
NIH
Bethesda, Maryland, United States
Amit R. Patel, MD

Professor
University of Virginia Health System
Charlottesville, Virginia, United States
AF

Afshin Farzaneh-Far, MD

Cardiologist
University of Illinois
Chicago, Illinois, United States
Chetan Shenoy, MBBS, MS

Associate Professor of Medicine
University of Minnesota
Minneapolis, Minnesota, United States
Steve W. Leung, MD, FSCMR

Associate Professor
University of Kentucky
Lexington, Kentucky, United States
Jorge A. Gonzalez, MD

Cardiologist
Scripps Clinic Medical Group
La Jolla, California, United States
Subha Raman, MD

Professor
IU Health/IU School of Medicine
Indianapolis, Indiana, United States
Dipan J. Shah, MD

Chief, Division of Cardiovascular Imaging
Houston Methodist DeBakey Heart & Vascular Center
Houston, Texas, United States
John F. Heitner, MD

Cardiologist
New York University Grossman School of Medicine
Brooklyn, New York, United States
Victor A. Ferrari, MD

Chair, Penn Cardiovascular Imaging Council
Hospital of the University of Pennsylvania and Penn Cardiovascular Institute
Phila., Pennsylvania, United States
Jeanette Schulz-Menger, MD

Professor
Charité – Universitätsmedizin Berlin, ECRC, MDC, Helios Klinikum Berlin Buch, DZHK, Berlin, Germany
Berlin, Berlin, Germany
Matthias Stuber, PhD

Professor
University Hospital (CHUV) and University of Lausanne (UNIL)
Lausanne, Switzerland
Orlando P. Simonetti, PhD

Professor, Medicine and Radiology
The Ohio State University
Columbus, Ohio, United States

Disclosure(s):

Steve W. Leung, MD, FSCMR: No relevant disclosure to display

Jorge A. Gonzalez, MD: No financial relationships to disclose

Dipan J. Shah, MD: No relevant disclosure to display

Jeanette Schulz-Menger, MD: No relevant disclosure to display

Background: Early invasive approach for moderate-severe myocardial ischemia characterized by nuclear perfusion and stress echocardiography did not demonstrate reduced adverse events in the ISCHEMIA trial. Large registry evidence can further understand the clinical utility of stress CMR.

Methods: In the 13-site SPINS observational study, 4,581 patients with stable chest pain syndromes who underwent stress CMR for clinical management were followed for composite events (MACE) of cardiovascular death (CVDEATH) and nonfatal MI within 4 yrs after the CMR. Target follow-up for death and nonfatal MI for >4 yrs was achieved in 96% of patients.

Results:

Patients with no ischemia or no LGE on stress CMR had very low annualized MACE event rates across a mean of 5.4 yrs (0.7% for no ischemia and no LGE vs 3.8% with ischemia, both P< 0.0001), with those with severe ischemia suffered the highest MACE (4.9%) (Figure 1, panel A-C). Cardiovascular death was lowest in patients with neither ischemia nor LGE compared to those with ischemia and LGE (0.25% vs 2.7%, P< 0.0001) (Figure 1, panel D). Ischemia extent (graded as mild, moderate, and severe) portended to progressive higher likelihood of MACE (panel E). Those with evidence of unrecognized MI (UMI) suffered significantly higher MACE (2.4% with vs 1.1% without UMI, P=< 0.0001). In patients with ischemia, left anterior descending coronary ischemia had the highest events (4.3%), compared to lowest in the left circumflex territory (3.8%, P=0.001) (panel F). Ischemia presence was associated with a substantial reduction of periods of event-free survival out of the hospital (3.9 vs 5 yrs, P< 0.0001).

Conclusion:

In a large multicenter registry, pts with normal stress CMR are at very low risk compared to 5-6-fold increased events in those with severe extent or LAD ischemia. Stress CMR should be further evaluated for guidance of revascularization in those at increased risk.