Stress Perfusion CMR Imaging-Guided Management and Prognosis in Patients With Suspected Coronary Heart Disease

BACKGROUND: Identifying patients with chronic coronary syndrome who will benefit most from a coronary revascularization strategy is essential. Data on the performance of stress cardiac magnetic resonance (CMR) to guide revascularization are limited. To assess the long-term prognostic impact of stress CMR-guided revascularization strategy to predict all-cause death. METHODS: We conducted an observational study including all consecutive patients who underwent stress CMR for suspected or known chronic coronary syndrome in 3 centers in France. CMR-guided coronary revascularization was defined as any revascularization performed within 90 days following stress CMR. The primary outcome was all-cause death. RESULTS: A total of 50 701 patients were included (mean age, 64±12 years; 68.5% men). After a median follow-up of 7.2 years (interquartile range, 3.0–11.0), 3665 (7.2%) patients died. Among the 7396 patients with ischemia, 6523 (88%) underwent revascularization. Ischemia and late gadolinium enhancement (LGE) without viability were independent predictors of death (adjusted hazard ratio, 3.67 [99.5% CI, 3.15–4.27] and adjusted hazard ratio, 1.26 [99.5% CI, 1.10–1.44], respectively; P <0.001 for both). CMR-guided revascularization was an independent predictor of improved survival in the overall population (adjusted hazard ratio, 0.30 [99.5% CI, 0.25–0.36]). In a 1:1 propensity-matched cohort of 1700 patients, CMR-guided revascularization remained independently associated with a lower incidence of death (adjusted hazard ratio, 0.37 [99.5% CI, 0.28–0.50]; P <0.001). This beneficial effect was observed in patients without LGE or with LGE and viability ( P <0.001 for both), but not in those with LGE without viability ( P =0.23). CONCLUSIONS: In this registry of consecutive patients with chronic coronary syndrome from 3 centers, stress CMR-guided revascularization was associated with a lower rate of death. The combined assessment of inducible myocardial ischemia and LGE may help to select patients most suitable for revascularization.