Journal article
Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain.
- Kwong RY Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: rykwong@bwh.harvard.org.
- Ge Y Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
- Steel K Cardiology Division, San Antonio Military Medical Center, San Antonio, Texas.
- Bingham S Revere Health, Provo, Utah.
- Abdullah S Veterans Administration North Texas Healthcare System, University of Texas Southwestern Medical Center, Dallas, Texas.
- Fujikura K Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
- Wang W Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
- Pandya A Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
- Chen YY Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
- Mikolich JR Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania.
- Boland S Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania.
- Arai AE National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
- Bandettini WP National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
- Shanbhag SM National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
- Patel AR Cardiology Division, Department of Medicine, University of Chicago, Chicago, Illinois.
- Narang A Cardiology Division, Department of Medicine, University of Chicago, Chicago, Illinois.
- Farzaneh-Far A Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
- Romer B Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
- Heitner JF Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York.
- Ho JY Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York.
- Singh J Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York.
- Shenoy C Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
- Hughes A Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
- Leung SW Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky.
- Marji M Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky.
- Gonzalez JA Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California.
- Mehta S Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California.
- Shah DJ Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
- Debs D Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
- Raman SV Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
- Guha A Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
- Ferrari VA Cardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
- Schulz-Menger J Charité, Medical Faculty of the Humboldt University, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Cardiology, Berlin, Germany.
- Hachamovitch R Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
- Stuber M Department of Radiology, University Hospital, University of Lausanne, Lausanne, Switzerland.
- Simonetti OP Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
- 2019-10-05
Published in:
- Journal of the American College of Cardiology. - 2019
cost of care
prognosis
stress cardiac magnetic resonance imaging
Aged
Chest Pain
Coronary Angiography
Coronary Artery Disease
Female
Humans
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardial Perfusion Imaging
Retrospective Studies
English
BACKGROUND
Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies.
OBJECTIVES
This study sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the United States.
METHODS
In this retrospective study, consecutive patients from 13 centers across 11 states who presented with a chest pain syndrome and were referred for stress CMR were followed for a target period of 4 years. The authors associated CMR findings with a primary outcome of cardiovascular death or nonfatal myocardial infarction using competing risk-adjusted regression models and downstream costs of ischemia testing using published Medicare national payment rates.
RESULTS
In this study, 2,349 patients (63 ± 11 years of age, 47% female) were followed for a median of 5.4 years. Patients with no ischemia or late gadolinium enhancement (LGE) by CMR, observed in 1,583 patients (67%), experienced low annualized rates of primary outcome (<1%) and coronary revascularization (1% to 3%), across all years of study follow-up. In contrast, patients with ischemia+/LGE+ experienced a >4-fold higher annual primary outcome rate and a >10-fold higher rate of coronary revascularization during the first year after CMR. Patients with ischemia and LGE both negative had low average annual cost spent on ischemia testing across all years of follow-up, and this pattern was similar across the 4 practice environments of the participating centers.
CONCLUSIONS
In a multicenter U.S. cohort with stable chest pain syndromes, stress CMR performed at experienced centers offers effective cardiac prognostication. Patients without CMR ischemia or LGE experienced a low incidence of cardiac events, little need for coronary revascularization, and low spending on subsequent ischemia testing. (Stress CMR Perfusion Imaging in the United States [SPINS]: A Society for Cardiovascular Resonance Registry Study; NCT03192891).
Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies.
OBJECTIVES
This study sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the United States.
METHODS
In this retrospective study, consecutive patients from 13 centers across 11 states who presented with a chest pain syndrome and were referred for stress CMR were followed for a target period of 4 years. The authors associated CMR findings with a primary outcome of cardiovascular death or nonfatal myocardial infarction using competing risk-adjusted regression models and downstream costs of ischemia testing using published Medicare national payment rates.
RESULTS
In this study, 2,349 patients (63 ± 11 years of age, 47% female) were followed for a median of 5.4 years. Patients with no ischemia or late gadolinium enhancement (LGE) by CMR, observed in 1,583 patients (67%), experienced low annualized rates of primary outcome (<1%) and coronary revascularization (1% to 3%), across all years of study follow-up. In contrast, patients with ischemia+/LGE+ experienced a >4-fold higher annual primary outcome rate and a >10-fold higher rate of coronary revascularization during the first year after CMR. Patients with ischemia and LGE both negative had low average annual cost spent on ischemia testing across all years of follow-up, and this pattern was similar across the 4 practice environments of the participating centers.
CONCLUSIONS
In a multicenter U.S. cohort with stable chest pain syndromes, stress CMR performed at experienced centers offers effective cardiac prognostication. Patients without CMR ischemia or LGE experienced a low incidence of cardiac events, little need for coronary revascularization, and low spending on subsequent ischemia testing. (Stress CMR Perfusion Imaging in the United States [SPINS]: A Society for Cardiovascular Resonance Registry Study; NCT03192891).
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.jacc.2019.07.074
- PMID 31582133
- Persistent URL
- https://sonar.ch/global/documents/798
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