TY - JOUR
T1 - Stress CMR Perfusion Imaging in the Medicare-Eligible Population
T2 - Insights From the SPINS Study
AU - Ge, Yin
AU - Antiochos, Panagiotis
AU - Bernhard, Benedikt
AU - Heydari, Bobak
AU - Steel, Kevin
AU - Bingham, Scott
AU - Mikolich, J. Ronald
AU - Arai, Andrew E.
AU - Bandettini, W. Patricia
AU - Patel, Amit R.
AU - Shanbhag, Sujata M.
AU - Farzaneh-Far, Afshin
AU - Heitner, John F.
AU - Shenoy, Chetan
AU - Leung, Steve W.
AU - Gonzalez, Jorge A.
AU - Shah, Dipan J.
AU - Raman, Subha V.
AU - Ferrari, Victor A.
AU - Schulz-Menger, Jeanette
AU - Stuber, Matthias
AU - Simonetti, Orlando P.
AU - Kwong, Raymond Y.
N1 - Publisher Copyright:
© 2025 American College of Cardiology Foundation
PY - 2025/1
Y1 - 2025/1
N2 - Background: Patients aged ≥65 years account for a disproportionately large portion of cardiovascular (CV) events and pose a challenge for noninvasive detection of coronary artery disease. Objectives: This study sought to determine the prognostic value of stress cardiac magnetic resonance (CMR) in a Medicare-eligible group of patients in a multicenter setting in the United States. Methods: From a multicenter U.S. registry, the study identified patients aged ≥65 years who were referred for stress CMR for evaluation of myocardial inducible ischemia. The primary outcome was defined as CV death or nonfatal myocardial infarction, whereas the secondary outcome was defined as any primary outcome, hospitalization for unstable angina, hospitalization for congestive heart failure, and unplanned late coronary artery bypass grafting. The associations of CMR findings with CV outcomes adjusted to clinical risk markers and health care cost spending were determined. Results: Among 1,780 patients (aged 73 ± 5.7 years; 46% female), study investigators observed 144 primary events and 323 secondary events, over a median follow-up of 4.8 years. The presence of inducible ischemia and late gadolinium enhancement (LGE) was associated with incrementally higher event rates. Patients with neither inducible ischemia nor LGE experienced a <1% annualized rate of primary outcome. In a multivariable model adjusted for CV risk factors, inducible ischemia and LGE maintained an independent association with primary (HR: 2.80 [95% CI: 1.93-4.05]; P < 0.001; and HR: 1.85 [95% CI: 1.21-2.82]; P = 0.004, respectively) and secondary (HR: 2.46 [95% CI: 1.90-3.19]; P < 0.001; and HR: 1.72 [95% CI: 1.30-2.27]; P < 0.001, respectively) outcomes. Rates of revascularization, as well as downstream costs for patients without CMR-detected inducible ischemia, remained low throughout the follow-up period. Conclusions: In a multicenter cohort of Medicare-eligible older patients, stress CMR was effective in providing risk stratification.
AB - Background: Patients aged ≥65 years account for a disproportionately large portion of cardiovascular (CV) events and pose a challenge for noninvasive detection of coronary artery disease. Objectives: This study sought to determine the prognostic value of stress cardiac magnetic resonance (CMR) in a Medicare-eligible group of patients in a multicenter setting in the United States. Methods: From a multicenter U.S. registry, the study identified patients aged ≥65 years who were referred for stress CMR for evaluation of myocardial inducible ischemia. The primary outcome was defined as CV death or nonfatal myocardial infarction, whereas the secondary outcome was defined as any primary outcome, hospitalization for unstable angina, hospitalization for congestive heart failure, and unplanned late coronary artery bypass grafting. The associations of CMR findings with CV outcomes adjusted to clinical risk markers and health care cost spending were determined. Results: Among 1,780 patients (aged 73 ± 5.7 years; 46% female), study investigators observed 144 primary events and 323 secondary events, over a median follow-up of 4.8 years. The presence of inducible ischemia and late gadolinium enhancement (LGE) was associated with incrementally higher event rates. Patients with neither inducible ischemia nor LGE experienced a <1% annualized rate of primary outcome. In a multivariable model adjusted for CV risk factors, inducible ischemia and LGE maintained an independent association with primary (HR: 2.80 [95% CI: 1.93-4.05]; P < 0.001; and HR: 1.85 [95% CI: 1.21-2.82]; P = 0.004, respectively) and secondary (HR: 2.46 [95% CI: 1.90-3.19]; P < 0.001; and HR: 1.72 [95% CI: 1.30-2.27]; P < 0.001, respectively) outcomes. Rates of revascularization, as well as downstream costs for patients without CMR-detected inducible ischemia, remained low throughout the follow-up period. Conclusions: In a multicenter cohort of Medicare-eligible older patients, stress CMR was effective in providing risk stratification.
KW - Medicare
KW - prognosis
KW - stress CMR
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U2 - 10.1016/j.jcmg.2024.07.029
DO - 10.1016/j.jcmg.2024.07.029
M3 - Article
C2 - 39425725
AN - SCOPUS:85212823896
SN - 1936-878X
VL - 18
SP - 33
EP - 44
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 1
ER -