Cardiac MRI, angiography similar at 3-year follow-up in CAD patients
Patients with stable coronary artery disease (CAD) monitored with either cardiac MR (CMR) or angiography demonstrated no difference in impact rates over three years, according to a recent JACC: Cardiovascular Imaging study.
Dominik Buckert, MD, with Germany’s University Hospital Ulm, and colleagues screened 394 patients from 2012 to 2014. They randomized 200 individuals to undergo either diagnostic coronary angiography or adenosine stress CMR.
Authors noted, in group one, a total of 45 revascularizations were performed, while the second saw 27 patients referred to revascularization.
At 12-month follow-up, cardiac death and non-fatal myocardial ischemia (MI) occurred in 3.1 percent of patients who received coronary angiography and 4.2 percent of those who underwent cardiac MRI.
Later, at three-year follow-up the rates of cardiac death and non-fatal MI jumped, respectively, to 4.1 percent and 9.4 percent in each group. Buckert et al. also noted at the three-year mark revascularization rates were no longer significantly different.
“The groups did not differ significantly for primary endpoint occurrence. However, patients in the CMR group had a slightly higher rate of cardiac events than patients in the standard treatment arm,” Buckert and colleagues wrote. “Consequently, noninferiority of the CMR-based strategy could not be proved after 3 years of follow-up.”
Three authors published a related editorial comparing the results of the Buckert-led MAGnet trial and the influential MR-INFORM trial that showed noninvasive imaging with stress perfusion cardiac MRI was non-inferior to angiography and fractional flow reserve (FFR) in guiding management of patients with known or suspected ischemic heart disease (IHD).
Colin Berry, PhD, with the University of Glasgow, and colleagues suggested the MAGnet and MR-INFORM results bolster the adoption of noninvasive myocardial imaging as an alternative reference strategy in patients with risk factors for IHD.
“The clinical utility of this strategy will improve with advances in technology and adherence with pharmacological and lifestyle interventions,” authors wrote. “For now, invasive coronary angiography (ICA) is the standard of care for decision making, but watch this space.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.