TY - JOUR
T1 - Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease
T2 - Insights From SPINS Retrospective Registry
AU - Heydari, Bobak
AU - Ge, Yin
AU - Antiochos, Panagiotis
AU - Islam, Sabeeh
AU - Steel, Kevin
AU - Bingham, Scott
AU - Abdullah, Shuaib
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 - Raman, Subha V.
AU - Ferrari, Victor A.
AU - Shah, Dipan J.
AU - Schulz-Menger, Jeanette
AU - Stuber, Matthias
AU - Simonetti, Orlando P.
AU - Kwong, Raymond Y.
N1 - Copyright © 2023. Published by Elsevier Inc.
PY - 2023/6
Y1 - 2023/6
N2 - BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of mortality in women, but current noninvasive cardiac imaging techniques have sex-specific limitations.OBJECTIVES: In this study, the authors sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization and costs of stress perfusion cardiac magnetic resonance (CMR) for suspected CVD.METHODS: Sex-specific prognostic performance was evaluated in a 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States [SPINS] Study) Registry. The primary outcome measure was a composite of cardiovascular death and nonfatal myocardial infarction; secondary outcomes were hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting.RESULTS: SPINS included 1,104 women (47% of cohort); women had higher prevalence of chest pain (62% vs 50%; P < 0.0001) but lower use of medical therapies. At the 5.4-year median follow-up, women with normal stress CMR had a low annualized rate of primary composite outcome similar to men (0.54%/y vs 0.75%/y, respectively; P = NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/y vs 0.54%/y; P < 0.0001) and secondary (9.8%/y vs 1.6%/y; P < 0.0001) outcomes compared with women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR: 2.64 [95% CI: 1.20-5.90]; P = 0.02) and secondary (HR: 2.09 [95% CI: 1.43-3.08]; P < 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary angiography (3.6% vs 7.3%; P = 0.0001) and downstream costs ($114 vs $171; P = 0.001) at 90 days following CMR. There was no effect of sex on diagnostic image quality.CONCLUSIONS: Stress CMR demonstrated excellent prognostic performance with lower rates of invasive coronary angiography referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women. (Stress CMR Perfusion Imaging in the United States [SPINS] Study [SPINS]; NCT03192891).
AB - BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of mortality in women, but current noninvasive cardiac imaging techniques have sex-specific limitations.OBJECTIVES: In this study, the authors sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization and costs of stress perfusion cardiac magnetic resonance (CMR) for suspected CVD.METHODS: Sex-specific prognostic performance was evaluated in a 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States [SPINS] Study) Registry. The primary outcome measure was a composite of cardiovascular death and nonfatal myocardial infarction; secondary outcomes were hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting.RESULTS: SPINS included 1,104 women (47% of cohort); women had higher prevalence of chest pain (62% vs 50%; P < 0.0001) but lower use of medical therapies. At the 5.4-year median follow-up, women with normal stress CMR had a low annualized rate of primary composite outcome similar to men (0.54%/y vs 0.75%/y, respectively; P = NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/y vs 0.54%/y; P < 0.0001) and secondary (9.8%/y vs 1.6%/y; P < 0.0001) outcomes compared with women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR: 2.64 [95% CI: 1.20-5.90]; P = 0.02) and secondary (HR: 2.09 [95% CI: 1.43-3.08]; P < 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary angiography (3.6% vs 7.3%; P = 0.0001) and downstream costs ($114 vs $171; P = 0.001) at 90 days following CMR. There was no effect of sex on diagnostic image quality.CONCLUSIONS: Stress CMR demonstrated excellent prognostic performance with lower rates of invasive coronary angiography referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women. (Stress CMR Perfusion Imaging in the United States [SPINS] Study [SPINS]; NCT03192891).
KW - cost-effectiveness
KW - ischemic heart disease
KW - prognosis
KW - stress CMR
KW - women
KW - Predictive Value of Tests
KW - Perfusion/adverse effects
KW - Myocardial Perfusion Imaging/methods
KW - Prognosis
KW - Humans
KW - Coronary Artery Disease/therapy
KW - Male
KW - Magnetic Resonance Imaging/methods
KW - Magnetic Resonance Imaging, Cine
KW - Myocardial Infarction
KW - Myocardial Ischemia/complications
KW - Female
KW - Registries
KW - Retrospective Studies
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UR - http://www.scopus.com/inward/citedby.url?scp=85156275151&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2022.11.025
DO - 10.1016/j.jcmg.2022.11.025
M3 - Article
C2 - 36764892
AN - SCOPUS:85156275151
SN - 1936-878X
VL - 16
SP - 749
EP - 764
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 6
ER -