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. (Stress CMR Perfusion Imaging in the United States [SPINS] study; NCT03192891).

中文翻译：

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符合 Medicare 资格的人群中的负荷 CMR 灌注成像：来自 SPINS 研究的见解。


背景 ≥ 65 岁的患者在心血管 （CV） 事件中占不成比例的大部分，对冠状动脉疾病的无创检测构成挑战。目的 本研究旨在确定美国多中心环境中符合 Medicare 条件的患者群体中负荷心脏磁共振 （CMR） 的预后价值。方法 从美国多中心登记处，该研究确定了年龄在 ≥65 岁的患者，这些患者被转诊进行负荷 CMR 以评估心肌诱发性缺血。主要结局定义为 CV 死亡或非致死性心肌梗死，而次要结局定义为任何主要结局，因不稳定型心绞痛住院、因充血性心力衰竭住院和计划外晚期冠状动脉旁路移植术。确定了 CMR 结果与根据临床风险标志物和医疗保健成本支出调整的 CV 结果的关联。结果 在 1,780 名患者 （年龄 73 ± 5.7 岁;46% 为女性） 中，研究人员在中位随访 4.8 年期间观察到 144 例原发事件和 323 例继发事件。诱导性缺血和晚期钆增强 （LGE） 的存在与事件发生率逐渐升高相关。既没有诱发性缺血也没有 LGE 的患者的主要结局年化率为 <1%。在针对 CV 危险因素调整的多变量模型中，诱发性缺血和 LGE 与原发性 （HR： 2.80 [95% CI： 1.93-4.05];P < 0.001;和 HR：1.85 [95% CI：1.21-2.82];P = 0.004）和继发性 （HR： 2.46 [95% CI： 1.90-3.19];P < 0.001;和 HR：1.72 [95% CI：1.30-2.27];P < 分别为 0.001）结果。 在整个随访期间，血运重建率以及未检测到 CMR 的诱导性缺血患者的下游成本一直很低。结论 在符合 Medicare 条件的老年患者的多中心队列中，压力 CMR 可有效提供风险分层。（美国负荷 CMR 灌注成像 [SPINS] 研究;NCT03192891）。