Greenwood, JP orcid.org/0000-0002-2861-0914, Herzog, BA, Brown, JM orcid.org/0000-0002-2719-7064 et al. (8 more authors) (2016) Prognostic value of cardiovascular magnetic resonance and single-photon emission computed tomography in suspected coronary heart disease: Long-term follow-up of a prospective, diagnostic accuracy cohort study. Annals of Internal Medicine, 165 (1). pp. 1-9. ISSN 0003-4819
Abstract
Background: There are no prospective, prognostic data comparing cardiovascular magnetic resonance (CMR) and singlephoton emission computed tomography (SPECT) in the same population of patients with suspected coronary heart disease (CHD). Objective: To establish the ability of CMR and SPECT to predict major adverse cardiovascular events (MACEs). Design: Annual follow-up of the CE-MARC (Clinical Evaluation of MAgnetic Resonance imaging in Coronary heart disease) study for a minimum of 5 years for MACEs (cardiovascular death, acute coronary syndrome, unscheduled revascularization or hospital admission for cardiovascular cause). (Current Controlled Trials registration: ISRCTN77246133) Setting: Secondary and tertiary care cardiology services. Participants: 752 patients from the CE-MARC study who were being investigated for suspected CHD. Measurements: Prediction of time to MACE was assessed by using univariable (log-rank test) and multivariable (Cox proportional hazards regression) analysis. Results: 744 (99%) of the 752 recruited patients had complete follow-up. Of 628 who underwent CMR, SPECT, and the reference standard test of X-ray angiography, 104 (16.6%) had at least 1 MACE. Abnormal findings on CMR (hazard ratio, 2.77 [95% CI, 1.85 to 4.16]; P < 0.001) and SPECT (hazard ratio, 1.62 [CI, 1.11 to 2.38; P = 0.014) were both strong and independent predictors of MACE. Only CMR remained a significant predictor after adjustment for other cardiovascular risk factors, angiography result, or stratification for initial patient treatment. Limitation: Data are from a single-center observational study (albeit conducted in a high-volume institution for both CMR and SPECT). Conclusion: Five-year follow-up of the CE-MARC study indicates that compared with SPECT, CMR is a stronger predictor of risk for MACEs, independent of cardiovascular risk factors, angiography result, or initial patient treatment. This further supports the role of CMR as an alternative to SPECT for the diagnosis and management of patients with suspected CHD. Primary Funding Source: British Heart Foundation.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2016, American College of Physicians. This is an author produced version of a paper published in Annals of Internal Medicine. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Biomedical Imaging Science Dept (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Inst of Clinical Trials Research (LICTR) (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 01 Sep 2016 09:44 |
Last Modified: | 29 Jun 2020 13:35 |
Published Version: | http://dx.doi.org/10.7326/M15-1801 |
Status: | Published |
Publisher: | American College of Physicians |
Identification Number: | 10.7326/M15-1801 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:104083 |