Stress CMR Perfusion Imaging in the Medicare-Eligible Population: Insights From the SPINS Study

Yin Ge; Panagiotis Antiochos; Benedikt Bernhard; Bobak Heydari; Kevin Steel; Scott Bingham; J Ronald Mikolich; Andrew E Arai; W Patricia Bandettini; Amit R Patel; Sujata M Shanbhag; Afshin Farzaneh-Far; John F Heitner; Chetan Shenoy; Steve W Leung; Jorge A Gonzalez; Dipan J Shah; Subha V Raman; Victor A Ferrari; Jeanette Schulz-Menger; Matthias Stuber; Orlando P Simonetti; Raymond Y Kwong

doi:10.1016/j.jcmg.2024.07.029

Stress CMR Perfusion Imaging in the Medicare-Eligible Population: Insights From the SPINS Study

JACC Cardiovasc Imaging. 2024 Oct 1:S1936-878X(24)00346-2. doi: 10.1016/j.jcmg.2024.07.029. Online ahead of print.

Authors

Yin Ge¹, Panagiotis Antiochos², Benedikt Bernhard³, Bobak Heydari⁴, Kevin Steel⁵, Scott Bingham⁶, J Ronald Mikolich⁷, Andrew E Arai⁸, W Patricia Bandettini⁸, Amit R Patel⁹, Sujata M Shanbhag⁸, Afshin Farzaneh-Far¹⁰, John F Heitner¹¹, Chetan Shenoy¹², Steve W Leung¹³, Jorge A Gonzalez¹⁴, Dipan J Shah¹⁵, Subha V Raman¹⁶, Victor A Ferrari¹⁷, Jeanette Schulz-Menger¹⁸, Matthias Stuber¹⁹, Orlando P Simonetti²⁰, Raymond Y Kwong²¹

Affiliations

¹ Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
² Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.
³ Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴ Stephenson Cardiac Imaging Center, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
⁵ St Joseph Medical Center, Bellingham, Washington, USA.
⁶ Revere Health, Provo, Utah, USA.
⁷ Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania, USA.
⁸ National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
⁹ Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA.
¹⁰ Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA.
¹¹ Cardiovascular Division, New York University Grossman School of Medicine, New York, New York, USA.
¹² Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
¹³ Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA.
¹⁴ Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California, USA.
¹⁵ Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
¹⁶ Indiana University Cardiovascular Institute and Krannert Cardiovascular Research Center, Indianapolis, Indiana, USA.
¹⁷ Cardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁸ Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Berlin, Germany.
¹⁹ Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
²⁰ Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.
²¹ Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: [email protected].

PMID: 39425725
DOI: 10.1016/j.jcmg.2024.07.029

Abstract

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).

Keywords: Medicare; prognosis; stress CMR.

Associated data

ClinicalTrials.gov/NCT03192891