Prognostic Value of Coronary Magnetic Resonance Angiography for Prediction of Cardiac Events in Patients With Suspected Coronary Artery Disease

Abstract

This study sought to determine whether whole-heart coronary magnetic resonance angiography (CMRA) can predict cardiac events in patients with suspected coronary artery disease. Recent studies demonstrated that the presence of stenosis on coronary computed tomography angiography has a significant prognostic impact on the prediction of cardiac events. However, the prognostic value of whole-heart CMRA is unknown. We studied 207 patients with suspected coronary artery disease who underwent non-contrast-enhanced free-breathing whole-heart CMRA acquired with a 1.5-T MR system and 32-channel cardiac coils. The presence of significant coronary stenosis (≥50% diameter reduction) was visually determined on sliding thin- maximum intensity projection images. Follow-up information was obtained for occurrence of severe cardiac events (cardiac death, myocardial infarction, and unstable angina) and all cardiac events (additionally including revascularization>90 days after CMRA). During a median follow-up of 25 months, 10 cardiac events, of which 5 were severe, were observed in 84 patients with significant stenosis. Whereas, in 123 patients without significant stenosis, only 1 cardiac event with no severe event was observed. Kaplan-Meier curves demonstrated a significant difference in event-free survival between the 2 groups for severe events (annual event rate, 3.9% and 0%, respectively; log-rank test, p = 0.003), as well as for all cardiac events (6.3% and 0.3%; p < 0.001). Cox regression analysis showed that presence of significant stenosis on CMRA was associated with a >20-fold hazard increase for all cardiac events (hazard ratio: 20.78; 95% confidence interval: 2.65 to 162.70; p = 0.001). Whole-heart CMRA is useful for predicting the future risk for cardiac events in patients with suspected coronary artery disease.