Prognostic Significance of Targeted Magnetic Resonance Coronary Angiography to Predict Cardiac Events in Patients with Known or Suspected Coronary Artery Disease

Abstract

Background: Magnetic resonance coronary angiography (MRCA) is one of the most promising tools for noninvasive imaging of coronary arteries without radiation exposure or contrast media administration. However, knowledge about the prognostic value of MRCA is limited. Materials and Methods: The present study included 389 patients with known or suspected coronary artery disease (CAD) underwent clinical cardiac magnetic resonance (CMR) including MRCA imaging. The presence of a significant coronary artery stenosis was defined by visual estimation of ≥50% diameter reduction using targeted MRCA images. Patients were followed up for hard cardiac events (cardiac death or non-fatal myocardial infarction) and major adverse cardiac events (MACE) which also included hospitalization for heart failure and late revascularization (>180 days after the CMR study). Results: The average age was 68±11 years and 48% were male. One hundred and thirty-nine patients had significant stenosis on MRCA. During a median follow-up period of 53.9 months, 23 hard cardiac events and 52 MACE, occurred. Patients with significant coronary artery stenosis had higher rates of hard cardiac events (annual event rate 3.12% versus 0.56%, HR 5.52, 95% CI 2.17 to 14.01, p<0.001) and MACE (annual event rate 6.44% versus 1.83%, HR 3.49, 95% CI 1.98 to 6.14, p<0.001) than those without significant stenosis. Multivariable analyses identified significant coronary artery stenosis as an independent predictor of hard cardiac events (HR 3.35, 95% CI 1.13 to 9.96, p=0.03) and MACE (HR 2.00, 95% CI 1.02 to 3.90, p=0.04). MRCA presented an incremental prognostic value over clinical factors, left ventricular ejection fraction, and myocardial scarring to predict hard cardiac events (p=0.03). Conclusion: Targeted MRCA demonstrated independent and incremental prognostic values to predict future cardiac events in patients with known or suspected CAD. Keywords: Cardiac magnetic resonance imaging; Coronary artery disease; Magnetic resonance coronary angiography; Prognosis