Absence of CMR Ischemia Effectively Rules Out Left Main, Multivessel Disease, and Serious Cardiovascular Events in a Multicentric United States Cohort of 4,149 Patients – Long Term Follow-up of the SCMR SPINS Registry

Presenting Author(s)

• MD

  Marianna Daibes, MD

  Postdoctoral Research Fellow
  Brigham and Women's Hospital

Primary Author(s)

• MD

  Marianna Daibes, MD

  Postdoctoral Research Fellow
  Brigham and Women's Hospital

Co-Author(s)

• IR

  Isabela Reis Marques, MD

  Postdoctoral Research Fellow
  Brigham and Women's Hospital
• BB

  Benedikt Bernhard

  MD
  Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
• 

  Yin Ge, MD

  MD
  Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
• PA

  Panagiotis Antiochos, MD

  Cardiologist
  Cardiac MR Center of the University Hospital Lausanne, CHUV, Switzerland, Switzerland
• BH

  Bobak Heydari, MD

  Professor, Harvard Medical School
  Brigham and Women's Hospital
• SI

  Sabeeh Islam

  Resident
  University at Buffalo
• NS

  Natalia Sanchez Santiuste, BSc

  Research Trainee
  Brigham and Women’s Hospital
• 

  Kevin Steel, DO

  .
  St Joseph Medical Center
• SB

  Scott E. Bingham, MD

  MD
  Revere Health, Provo, Utah, USA
• JM

  J Ronald Mikolich, MD

  MD
  Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania, USA
• 

  Andrew Arai, MD

  Professor
  Division of Cardiovascular Medicine, Department of Medicine, Department of Radiology, University of Utah School of Medicine
• PB

  Patricia W. Bandettini, MD, MSCMR, FACC

  Chief, NHLBI Clinical Cardiovascular MRI Program and Core, Senior Research Physician
  National Heart, Lung, and Blood Institute, National Institutes of Health
  NIH
• 

  Amit R. Patel, MD

  Professor of Medicine
  Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA.
• 

  Sujata M Shanbhag, MD

  MD
  Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
• AF

  Afshin Farzaneh-Far, MD

  MD
  Cardiology Division, University of Illinois, Chicago, Illinois, USA
• 

  John F Heitner, MD

  MD
  Cardiovascular Division, New York University Grossman School of Medicine, New York, New York, USA
• 

  Chetan Shenoy, MBBS, MS

  MD
  Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
• 

  Steve Leung, MD, FSCMR

  Professor
  University of Kentucky
• 

  Jorge A A. Gonzalez, MD

  MD
  Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California, USA
• 

  Subha Raman, MD

  Vice President
  OhioHealth
• 

  Victor A Ferrari, MD

  MD
  Hospital of the University of Pennsylvania and Penn Cardiovascular Institute, Philadelphia, Pennsylvania, USA.
• 

  Dipan J. Shah, MD

  Chief, Division of Cardiovascular Imaging Director, Cardiovascular MRI Laboratory
  Weill Cornell Medical College, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
• AB

  Akila Bersali, MD

  Research fellow
  Houston Methodist DeBakey Heart & Vascular Center
• 

  Jeanette Schulz-Menger, MD

  Head Working Group Cardiac MRI
  Charité/ University Medicine Berlin and Helios, Germany
• 

  Mathias Stuber, PhD

  Full Professor
  CIBM-CHUV-UNIL
  Laussane University, Switzerland
• 

  Orlando P. Simonetti, PhD

  Professor
  The Ohio State University
• 

  Raymond Y. Kwong, MD

  Professor of Medicine
  Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA

Background: Left main (LMD) and multivessel coronary disease (MVD) are associated with high risk of serious cardiovascular (CV) events. Small single-center studies demonstrated that stress CMR, with its high imaging resolution, offers excellent diagnostic accuracy and risk stratification. 

Methods: 4,149 consecutive patients from 13 US centers were followed for a median of 5.1 years (3 years minimum). Angiographically significant LMD (≥50%) and MVD (two-vessel: LAD and LCX both ≥70% or three-vessel: all ≥70% stenosis) were determined from all available coronary angiograms performed within 36 months after the CMR. Clinical outcome included 3-year composite MACE including CV death, acute MI, and LMD/MVD. We categorized ischemia using the AHA 16-segment model into four grades: 0, 1-2, 3-5, and more than 5 ischemia segments.

Results: Patients who had LMD/MVD were more likely to be older and have a history of diabetes, previous AMI, hypertension, lower ejection fraction, and positive late gadolinium enhancement. Patients with ischemia (N=767, 19%) experienced an annual rate of LMD/MVD, CV death/AMI, and overall composite MACE at 3.0%, 3.8%, and 6.1%, respectively; compared with those without ischemia (N=3,382, 81%), who had 0.3%, 0.8%, and 1.0%, respectively (Figure 1). Figure 2 illustrates the progressively higher annual event rates by ischemia grade, with patients with severe ischemia experiencing 4.5%, 5.5%, and 9.1% annual rates for CV death/AMI, LMD/MVD, and MACE, respectively. Ischemia presence maintained a 4.6-fold increased risk for MACE adjusted for common major risk markers (OR 4.67, 95% CI: 3.42–6.37) (table 1).  

Conclusion: In the large US multicenter SPINS stable chest pain cohort, >99% of patients with no CMR ischemia experienced freedom from any LMD/MVD diagnosis or serious cardiac events.  

Figure 1. Annual rates of MACE including CV death, acute MI, and LMD/MVD, stratified by presence and absence of ischemia.

Figure 2. Annual rates of MACE including CV death, acute MI, and LMD/MVD, stratified by extent of ischemia.