Prognostic yield of stress CMR to evaluate chronic coronary syndromes: a systematic review and meta-analysis

Abstract

Abstract Background Assessment of ischemia with stress cardiovascular magnetic resonance (CMR) imaging is recommended in patients with stable chest pain and intermediate or high pre-test probability of coronary artery disease (CAD). Purpose To provide an updated synthesis on prognostic significance of stress CMR imaging in patients with stable chest pain and suspected or known CAD. Methods After prospective registration and approval of the study protocol, we performed a systematic review and meta-analysis of studies published between 2000 through 2021, enrolling ≥100 patients, and reporting outcome data of CAD patients undergoing stress CMR. Odds ratios (ORs) and 95% confidence intervals (CIs) for all-cause death, cardiovascular (CV) death and major adverse cardiac events (MACE: CV death and myocardial infarction), were pooled through inverse variance random-effects meta-analysis to compute summary effect size. Annualized event rates (AERs) were extracted from each study and compared by χ2-statistic. A warranty period was defined as the time interval with an AER <1%. Results We identified a total of 33 studies pooling an overall tested population of 68920 patients (mean age 62 years; 56% males; known CAD 32%; 386117 person-years). Ischemia was found in 13617 (20%). Mean follow-up was 3.5±2.1 years. Presence of ischemia was associated with increased risk of all-cause death (OR 2.0 95% CI: 1.7–2.3), CV death (OR 6.4 95% CI: 4.5–9.1), and MACE (OR 5.0 95% CI: 3.6–6.8). Cumulative AERs for all-cause death, CV death and MACE were 2.97%, 2.51%, and 3.99% in patients with ischemia, and 1.40%, 0.59%, and 0.98% in patients without ischemia, respectively (p<0.0001 for all comparisons). Conclusion Stress CMR imaging yields robust prognostic information in patients with suspected or known CAD. Presence of ischemia is associated with increased risk of all-cause death, CV death and MACE. Patients with negative stress CMR have a very low risk (<1%) of CV death and MACE with a warranty period of at least 3.5 years. Funding Acknowledgement Type of funding sources: None.