Cardiac MRI, stress test improves mortality prediction

Stress cardiac MRI (CMR) greatly improved the accuracy of mortality prediction in patients with known or suspected coronary artery disease (CAD), reported authors of a large, multi-center study published in JAMA Cardiology.

John Heitner, MD, with New York Presbyterian Brooklyn Methodist Hospital and colleagues included more than 9,000 patients in real-world settings with known or suspected CAD in their study. All patients underwent stress CMR and were followed for up to 10 years after the initial test.

The use of stress CMR improved the accuracy of mortality prediction in two different risk models—in the overall patient population and in a group of 14 different subpopulations defined by a history of CAD and left ventricular ejection fraction.

Additionally, after adjusting for patient age, sex and cardiac risk factors, a Kaplan-Meier survival analysis found a strong correlation between abnormal stress CMR and mortality in all patients, those with and without a history of CAD and groups with normal and abnormal left ventricular ejection fraction.

“These findings suggest that stress CMR has broad prognostic significance regardless of patient age, symptoms or risk factors,” the authors wrote. “Accordingly, while real-world evidence studies may in general be more susceptible to patient selection bias compared with randomized clinical trial studies, the consistent Kaplan-Meier findings across 16 different cross-sections of a heterogeneous multicenter population suggest that patient selection bias is unlikely to affect the primary conclusion of our study: that stress CMR is significantly associated with mortality.”