Coronary magnetic resonance angiography (CMRA) allows non-ionizing visualization of luminal narrowing in coronary artery disease (CAD). Although a prior study showed the usefulness of CMRA for risk stratification in short-term follow-up, the long-term prognostic value of CMRA remains unclear. The purpose of this study was to evaluate the long-term prognostic value of CMRA. A total of 506 patients without history of myocardial infarction or prior coronary artery revascularization underwent free-breathing whole-heart CMRA between 2009 and 2015. Images were acquired using a 1.5 T or 3 T scanner and visually evaluated as the consensus decisions of two observers. Obstructive CAD on CMRA was defined as luminal narrowing of ≥ 50% in at least one coronary artery. Major adverse cardiac events (MACE) comprised cardiac death, nonfatal myocardial infarction, and unstable angina. Obstructive CAD on CMRA was observed in 214 patients (42%). During follow-up (median, 5.6 years), 31 MACE occurred. Kaplan–Meier curve analysis revealed a significant difference in event-free survival between patients with and without obstructive CAD for MACE (log-rank, p = 0.003) and cardiac death (p = 0.012). Annualized event rates for MACE in patients with no obstructive CAD, 1-vessel disease, 2-vessel disease, and left-main or 3-vessel disease were 0.6%, 1.5%, 2.3%, and 3.6%, respectively (log-rank, p = 0.003). Cox proportional hazard regression analysis showed that, among obstructive CAD on CMRA and clinical risk factors (age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of CAD), obstructive CAD and diabetes were significant predictors of MACE (hazard ratios, 2.9 [p = 0.005] and 2.2 [p = 0.034], respectively). In multivariate analysis, obstructive CAD remained an independent predictor (adjusted hazard ratio, 2.6 [p = 0.010]) after adjusting for diabetes. Addition of obstructive CAD to clinical risk factors significantly increased the global chi-square result from 8.3 to 13.8 (p = 0.022). In long-term follow-up, free breathing whole heart CMRA allows non-invasive risk stratification for MACE and cardiac death and provides incremental prognostic value over conventional risk factors in patients without a history of myocardial infarction or prior coronary artery revascularization. The presence and severity of obstructive CAD detected by CMRA were associated with worse prognosis. Importantly, patients without obstructive CAD on CMRA displayed favorable prognosis.

中文翻译：

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全心冠状动脉磁共振血管造影的长期预后价值


冠状动脉磁共振血管造影 (CMRA) 可以对冠状动脉疾病 (CAD) 中的管腔狭窄进行非电离可视化。尽管先前的研究表明 CMRA 对于短期随访中风险分层的有用性，但 CMRA 的长期预后价值仍不清楚。本研究的目的是评估 CMRA 的长期预后价值。 2009 年至 2015 年间，共有 506 名没有心肌梗死病史或既往冠状动脉血运重建的患者接受了自由呼吸全心 CMRA。使用 1.5 T 或 3 T 扫描仪获取图像，并根据两名观察者的一致决定进行视觉评估。 CMRA 上的阻塞性 CAD 定义为至少一根冠状动脉的管腔狭窄≥ 50%。主要不良心脏事件（MACE）包括心源性死亡、非致命性心肌梗死和不稳定型心绞痛。在 214 名患者 (42%) 中观察到 CMRA 阻塞性 CAD。在随访期间（中位时间 5.6 年），发生了 31 例 MACE。 Kaplan-Meier 曲线分析显示，患有和不患有阻塞性 CAD 的患者之间的 MACE（对数秩，p = 0.003）和心源性死亡（p = 0.012）的无事件生存率存在显着差异。无阻塞性 CAD、1 支血管疾病、2 支血管疾病以及左主干或 3 支血管疾病患者的 MACE 年化事件发生率分别为 0.6%、1.5%、2.3% 和 3.6%（对数秩，p = 0.003）。 Cox 比例风险回归分析显示，在 CMRA 上的阻塞性 CAD 和临床危险因素（年龄、性别、高血压、糖尿病、血脂异常、吸烟和 CAD 家族史）中，阻塞性 CAD 和糖尿病是 MACE 的显着预测因子（风险比、分别为 2.9 [p = 0.005] 和 2.2 [p = 0.034]）。 在多变量分析中，在调整糖尿病后，阻塞性 CAD 仍然是一个独立的预测因素（调整后的风险比为 2.6 [p = 0.010]）。将阻塞性 CAD 添加到临床危险因素中后，总体卡方结果从 8.3 显着增加至 13.8 (p = 0.022)。在长期随访中，自由呼吸全心 CMRA 可以对 MACE 和心源性死亡进行无创风险分层，并为没有心肌梗死史或既往冠状动脉血运重建史的患者提供比传统风险因素更高的预后价值。 CMRA 检测到的阻塞性 CAD 的存在及其严重程度与较差的预后相关。重要的是，CMRA 上没有梗阻性 CAD 的患者表现出良好的预后。