Prognostic value of CMR and SPECT in suspected coronary heart disease: long term follow-up of the CE-MARC study
KeywordsSingle Photon Emission Compute Tomography Cardiovascular Risk Factor Cardiovascular Magnetic Resonance Major Adverse Cardiovascular Event Integrate Discrimination Improvement
CE-MARC established the comparative diagnostic performance of cardiovascular magnetic resonance (CMR) and single photon emission computed tomography (SPECT) in patients with suspected coronary heart disease. However, there are no prospective, prognostic data comparing the two modalities in the same patient population. Our objective was to establish the comparative ability of CMR and SPECT to predict major adverse cardiovascular events.
Design: Predefined analysis of the CE-MARC trial with all patients undergoing annual follow-up for at least 5 years to assess the occurrence of major adverse cardiovascular events (cardiovascular death, acute coronary syndrome, unscheduled revascularization or hospital admission for any cardiovascular cause).
Setting: Secondary and tertiary care cardiology services.
Participants: 752 patients from CE-MARC who were under investigation for suspected coronary heart disease by a cardiologist.
Measurements: Prediction of time to major adverse cardiovascular events was assessed by univariate (log-rank test) and multivariate (Cox proportional hazards regression) analysis after adjustment for major cardiovascular risk factors. In addition net reclassification improvement (NRI) and integrated discrimination improvement (IDI) assessed whether the addition of CMR or SPECT to major cardiovascular risk factors improved the prediction of the risk of major adverse cardiovascular events.
744(99%) of 752 patients recruited had complete follow-up. Of 633 who underwent both CMR and SPECT, 105(16.6%) had at least 1 major adverse cardiovascular event. Abnormal CMR (HR 2.77; 95%CI, 1.85-4.16; p < 0.0001) and abnormal SPECT (HR 1.63; 95%CI, 1.11-2.39; p = 0.013) were both strong and independent predictors of major adverse cardiovascular events. Only CMR remained a significant predictor after adjustment for other cardiovascular risk factors and only CMR showed improved reclassification and risk stratification (NRI 0.51(95%CI 0.26-0.76); IDI 0.02(95%CI 0.005-0.05)).
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.