Association of Adverse Clinical Outcomes With Peri-Infarct Ischemia Detected by Stress Cardiac Magnetic Imaging.

Authors

Benedikt Bernhard
Yin Ge
Panagiotis Antiochos
Bobak Heydari
Sabeeh Islam
Natalia Sanchez Santiuste
Kevin E 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
Subha V Raman, OhioHealth
Victor A Ferrari
Dipan J Shah
Jeanette Schulz-Menger
Matthias Stuber
Orlando P Simonetti
Raymond Y Kwong

Document Type

Article

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND: Early invasive revascularization guided by moderate to severe ischemia did not improve outcomes over medical therapy alone, underlying the need to identify high-risk patients for a more effective invasive referral. CMR could determine the myocardial extent and matching locations of ischemia and infarction.

OBJECTIVES: This study sought to investigate if CMR peri-infarct ischemia is associated with adverse events incremental to known risk markers.

METHODS: Consecutive patients were included in an expanded cohort of the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study. Peri-infarct ischemia was defined by the presence of any ischemic segment neighboring an infarcted segment by late gadolinium enhancement imaging. Primary outcome events included acute myocardial infarction and cardiovascular death, whereas secondary events included any primary events, hospitalization for unstable angina, heart failure hospitalization, and late coronary artery bypass surgery.

RESULTS: Among 3,915 patients (age: 61.0 ± 12.9 years; 54.7% male), ischemia, infarct, and peri-infarct ischemia were present in 752 (19.2%), 1,123 (28.8%), and 382 (9.8%) patients, respectively. At 5.3 years (Q1-Q3: 3.9-7.2 years) of median follow-up, primary and secondary events occurred in 406 (10.4%) and 745 (19.0%) patients, respectively. Peri-infarct ischemia was the strongest multivariable predictor for primary and secondary events (HR

CONCLUSIONS: Peri-infarct ischemia is a novel and robust prognostic marker of adverse cardiovascular events.

First Page

417

Last Page

429

DOI

10.1016/j.jacc.2024.04.062

Publication Date

7-30-2024

Recommended Citation

Bernhard, Benedikt; Ge, Yin; Antiochos, Panagiotis; Heydari, Bobak; Islam, Sabeeh; Sanchez Santiuste, Natalia; Steel, Kevin E; Bingham, Scott; Mikolich, J Ronald; Arai, Andrew E; Bandettini, W Patricia; Patel, Amit R; Shanbhag, Sujata M; Farzaneh-Far, Afshin; Heitner, John F; Shenoy, Chetan; Leung, Steve W; Gonzalez, Jorge A; Raman, Subha V; Ferrari, Victor A; Shah, Dipan J; Schulz-Menger, Jeanette; Stuber, Matthias; Simonetti, Orlando P; and Kwong, Raymond Y, "Association of Adverse Clinical Outcomes With Peri-Infarct Ischemia Detected by Stress Cardiac Magnetic Imaging." (2024). Heart and Vascular Articles. 56.
https://scholarlyworks.ohiohealth.com/heart-vascular-articles/56