Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain.
OBJECTIVE
This study was designed to determine the diagnostic value of adenosine cardiac magnetic resonance (CMR) in troponin-negative patients with chest pain.


BACKGROUND
We hypothesized that adenosine CMR could determine which troponin-negative patients with chest pain in an emergency department have coronary artery disease (CAD) or future adverse cardiac events.


METHODS
Adenosine stress CMR was performed on 135 patients who presented to the emergency department with chest pain and had acute myocardial infarction (MI) excluded by troponin-I. The main study outcome was detecting any evidence of significant CAD. Patients were contacted at one year to determine the incidence of significant CAD defined as coronary artery stenosis >50% on angiography, abnormal correlative stress test, new MI, or death.


RESULTS
Adenosine perfusion abnormalities had 100% sensitivity and 93% specificity as the single most accurate component of the CMR examination. Both cardiac risk factors and CMR were significant in Kaplan-Meier analysis (log-rank test, p = 0.0006 and p < 0.0001, respectively). However, an abnormal CMR added significant prognostic value in predicting future diagnosis of CAD, MI, or death over clinical risk factors. In receiver operator curve analysis, adenosine CMR was a more accurate predictor than cardiac risk factors (p < 0.002).


CONCLUSIONS
In patients with chest pain who had MI excluded by troponin-I and non-diagnostic electrocardiograms, an adenosine CMR examination predicted with high sensitivity and specificity which patients had significant CAD during one-year follow-up. Furthermore, no patients with a normal adenosine CMR study had a subsequent diagnosis of CAD or an adverse outcome.
Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, and Suburban Hospital, Bethesda, Maryland 20892-1061, USA.
W Patricia
WP
Ingkanisorn
Raymond Y
RY
Kwong
Nicole S
NS
Bohme
Nancy L
NL
Geller
Kenneth L
KL
Rhoads
Christopher K
CK
Dyke
D Ian
DI
Paterson
Mushabbar A
MA
Syed
Anthony H
AH
Aletras
Andrew E
AE
Arai
D000241:Adenosine; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D003324:Coronary Artery Disease / Q000209:etiology*; D004632:Emergency Medical Services; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis
D000241:Adenosine