Author + information
- Received January 9, 2018
- Revision received May 4, 2018
- Accepted May 11, 2018
- Published online July 2, 2018.
- Dominik Buckert, MDa,∗ (, )
- Simon Witzel, MDa,
- Jürgen M. Steinacker, MDa,
- Wolfgang Rottbauer, MDa and
- Peter Bernhardt, MDb
- ↵∗Address for correspondence:
Dr. Dominik Buckert, Department of Internal Medicine II, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
Objectives The purpose of this study was the prospective and randomized evaluation of cardiovascular endpoints and quality of life in patients with stable coronary artery disease comparing a cardiac magnetic resonance (CMR)–based management strategy with a coronary angiography–based approach.
Background Evidence from trials prospectively evaluating the role of CMR in clinical pathways and decision processes is limited.
Methods Patients with symptomatic CAD were randomized to diagnostic coronary angiography (group 1) or adenosine stress CMR (group 2). The primary endpoint was the composite of cardiac death and nonfatal myocardial infarction. Quality of life was assessed using the Seattle Angina Questionnaire at baseline and during follow-up.
Results Two hundred patients were enrolled. In group 1, 45 revascularizations (45.9%) were performed. In group 2, 27 patients (28.1%) were referred to revascularization because of ischemia on CMR. At 12-month follow-up, 7 primary events occurred: 3 in group 1 (event rate 3.1%) and 4 in group 2 (event rate 4.2%), with no statistically significant difference (p = 0.72). Within the next 2 years, 6 additional events could be observed, giving 4 events in group 1 and 9 events in group 2 (event rate 4.1% vs. 9.4%; p = 0.25). Group 2 showed significant quality-of-life improvement after 1 year in comparison to group 1.
Conclusions A CMR-based management strategy for patients with stable coronary artery disease was safe, reduced revascularization procedures, and resulted in better quality of life at 12-month follow-up, though noninferiority could not be proved. Optimal timing for reassessment remains to be investigated. (Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary Intervention [MAGnet]; NCT02580851)
- cardiovascular magnetic resonance imaging
- inducible ischemia
- patient management
- prognosis and outcomes
- stable coronary artery disease
This trial has been partially funded by Guerbet. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 9, 2018.
- Revision received May 4, 2018.
- Accepted May 11, 2018.
- 2018 American College of Cardiology Foundation