title: Prognostic value of adenosine cardiac magnetic resonance imaging in patients presenting with chest pain.
abstract: Adenosine cardiac magnetic resonance imaging (AS-CMR) has emerged as an alternative to other stress tests for identifying coronary artery disease. From January 1, 2002 to January 1, 2009, 564 consecutive patients underwent AS-CMR for evaluation of chest pain. The clinical characteristics, AS-CMR findings, and outcomes were evaluated by retrospective chart review and telephone interview. The median follow-up was 51 months. Major adverse cardiac events (MACE) were defined as cardiac death, nonfatal myocardial infarction, and revascularization with percutaneous coronary intervention or bypass surgery. The AS-CMR findings were normal in 264, ischemic in 201, and scar in 240 patients. No cardiac death occurred in the normal AS-CMR group. Among the ischemic and scar groups, 7.2% and 8.3% experienced an event, respectively. On univariate analysis, ischemia (hazard ratio 5.3, 95% confidence interval 2.5 to 11.5, p <0.001) and the presence of scar (hazard ratio 5.7, 95% confidence interval 2.6 to 12.4, p <0.001) were independent predictors of all cardiac events. Multivariate Cox regression analysis for MACE identified the presence of ischemia (hazard ratio 2.8, 95% confidence interval 1.2 to 6.2, p = 0.01) and scarring (hazard ratio 2.9, 95% confidence interval 1.3 to 6.6, p = 0.01) as the strongest independent factors. The annual event rate for hard events was 0% in the normal, 1.7% in the scar, and 1.5% in the ischemia group. For the MACE end points, the rate was 0.5% in the normal, 2.4% in the scar, and 2.6% in the ischemia group. In conclusion, in the present, single-center cohort with chest pain, normal AS-CMR findings conferred very low risk (<1% annually) of MACE. However, the findings of ischemia or scar were a significant and independent predictor of hard events and MACE.
authors.affiliation: University of Illinois College of Medicine at Peoria, St. Francis Health System, Peoria, IL, USA. rrmacwar@uic.edu
authors.forename: Rachid R
authors.initials: RR
authors.lastname: Macwar
authors.forename: Brent A
authors.initials: BA
authors.lastname: Williams
authors.forename: Jamshid
authors.initials: J
authors.lastname: Shirani
mesh_terms: D000241:Adenosine; D000368:Aged; D002315:Cardiopulmonary Bypass; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology*; D003287:Contrast Media; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007407:Interviews as Topic; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D014665:Vasodilator Agents
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D019786:Gadolinium DTPA; D000241:Adenosine