To assess the incremental long-term prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance (CMR) in patients without known coronary artery disease (CAD). Between 2010 and 2011, consecutive patients with cardiovascular risk factors without known CAD referred for stress CMR were followed for the occurrence of major adverse cardiac events (MACE), defined by cardiovascular mortality or recurrent non-fatal myocardial infarction (MI). Uni- and multivariable Cox regressions were performed to determine the prognostic value of ischemia and unrecognized MI defined by sub-endocardial or transmural late gadolinium enhancement (LGE). Among 2,295 patients without known CAD, 2058 (89.7%) (71.2 ± 12.5 years; 37.5% males) completed the follow-up (median [IQR]: 8.3 [7.3–8.7] years), and 203 had MACE (9.9%). Using Kaplan–Meier analysis, ischemia and unrecognized MI were associated with MACE (hazard ratio, HR: 4.64 95% CI: 3.69–6.17 and HR: 2.88; 95% CI: 2.08–3.99, respectively; both p < 0.001). In multivariable stepwise Cox regression, ischemia and unrecognized MI were independent predictors of MACE (HR = 3.71; 95% CI 2.73–5.05, p < 0.001 and HR = 1.73; 95% CI 1.22–2.45, p = 0.002; respectively) and cardiovascular mortality (HR: 3.13; 95% CI: 2.17–4.51, p < 0.001 and HR = 1.73; 95% CI 1.15–2.62, p = 0.009; respectively). The addition of ischemia and unrecognized MI led to an improved model discrimination for MACE (change in C statistic from 0.61 to 0.72; NRI = 0.431; IDI = 0.053). Inducible ischemia and unrecognized MI identified by stress CMR have incremental long term prognostic value for the incidence of MACE in patients without known CAD over traditional risk factors and left ventricular ejection fraction.

中文翻译：

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压力灌注心血管磁共振对无已知冠状动脉疾病患者的长期预后价值

评估血管扩张剂应激灌注心血管磁共振 (CMR) 在没有已知冠状动脉疾病 (CAD) 的患者中增加的长期预后价值。在 2010 年至 2011 年期间，连续对具有心血管危险因素且无已知 CAD 转诊进行负荷 CMR 的患者进行了主要不良心脏事件 (MACE) 的随访，该事件定义为心血管死亡率或复发性非致命性心肌梗死 (MI)。进行单变量和多变量 Cox 回归以确定由心内膜下或透壁晚期钆增强 (LGE) 定义的缺血和未识别 MI 的预后价值。在 2,295 名无已知 CAD 的患者中，2058 名 (89.7%)（71.2 ± 12.5 岁；37.5% 男性）完成了随访（中位 [IQR]：8.3 [7.3-8.7] 年），203 名患有 MACE (9.9%) . 使用 Kaplan-Meier 分析，缺血和未识别的 MI 与 MACE 相关（风险比，HR：4.64 95% CI：3.69–6.17 和 HR：2.88；95% CI：2.08–3.99；两者均 p < 0.001）。在多变量逐步 Cox 回归中，缺血和未识别的 MI 是 MACE 的独立预测因子（HR = 3.71；95% CI 2.73–5.05，p < 0.001 和 HR = 1.73；95% CI 1.22–2.45，p = 0.002；分别）和心血管事件死亡率（HR：3.13；95% CI：2.17–4.51，p < 0.001 和 HR = 1.73；95% CI 1.15–2.62，p = 0.009；分别）。缺血和未识别的 MI 的添加导致了 MACE 模型区分的改进（C 统计量从 0.61 变为 0.72；NRI = 0.431；IDI = 0.053）。