Prognostic value of adenosine stress cardiovascular magnetic resonance in patients with low-risk chest pain.
BACKGROUND
Approximately 5% of patients with an acute coronary syndrome are discharged from the emergency room with an erroneous diagnosis of non-cardiac chest pain. Highly accurate non-invasive stress imaging is valuable for assessment of low-risk chest pain patients to prevent these errors. Adenosine stress cardiovascular magnetic resonance (AS-CMR) is an imaging modality with increasing application. The goal of this study was to evaluate the negative prognostic value of AS-CMR among low-risk acute chest pain patients.


METHODS
We studied 103 patients, mean 56.7 + or - 12.3 years of age, with chest pain and no electrocardiographic evidence of ischemia and negative cardiac biomarkers of necrosis, who were admitted to the Cardiac Decision Unit of our institution. All patients underwent AS-CMR. A negative AS-CMR was defined as absence of all the following: regional wall motion abnormalities at rest; perfusion defects during stress (adenosine) and rest; and myocardial scar on late gadolinium enhancement images. The patients were followed for a mean of 277 (range 161-462) days. The primary end point was defined as the combination of cardiac death, nonfatal acute myocardial infarction, re-hospitalization for chest pain, obstructive coronary artery disease (>50% coronary stenosis on invasive angiography) and coronary revascularization.


RESULTS
In 14 patients (13.6%), AS-CMR was positive. The remaining 89 patients (86.4%), who had negative AS-CMR, were discharged. No patient with negative AS-CMR reached the primary end-point during follow-up. The negative predictive value of AS-CMR was 100%.


CONCLUSIONS
AS-CMR holds promise as a useful tool to rule out significant coronary artery disease in patients with low-risk chest pain. Patients with negative AS-CMR have an excellent short and mid-term prognosis.
Lerakis
Stamatios
S
Department of Medicine and Division of Cardiology, Emory University School of Medicine, 1365 Clifton Road NE, Suite AT-500-508, Atlanta GA, 30322, USA. sleraki@emory.edu
McLean
Dalton S
DS
Anadiotis
Athanasios V
AV
Janik
Matthew
M
Oshinski
John N
JN
Alexopoulos
Nikolaos
N
Zaragoza-Macias
Elisa
E
Veledar
Emir
E
Stillman
Arthur E
AE
D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D000241:Adenosine; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D009204:Myocardial Revascularization; D010351:Patient Discharge; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
D000241:Adenosine