Coronary disease & ACSMeta-analysis
Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease
- Systematic review and meta-analysis of diagnostic and prognostic studies
- PRISMA
Authors' conclusion
In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.
Study context
- Population
- Stable chest pain with known or suspected CAD
- Participants
- 74,470 participants · 64 studies
- Outcome
- Diagnostic accuracy (DOR, sensitivity, specificity, AUROC) and prognostic value (OR, annualized event rate) for all-cause death, CV death and MACE (MI and CV death)
Pooled result
As reported in the abstract
Detection of functionally obstructive CAD
| Group | DOR | Sensitivity | Specificity | AUROC |
|---|---|---|---|---|
| Stress CMR | 26.4 (95% CI, 10.6-65.9) | 81% (95% CI, 68%-89%) | 86% (95% CI, 75%-93%) | 0.84 (95% CI, 0.77-0.89) |
Further pooled results
| Outcome | Values | OR (95% CI) | |
|---|---|---|---|
| Prognosis: stress-inducible ischemia · mean [SD] follow-up 3.5 [2.1] years — Inducible ischemia vs No ischemia · all-cause mortality | 1.97 (1.69–2.31) | ||
| Prognosis: stress-inducible ischemia · mean [SD] follow-up 3.5 [2.1] years — Inducible ischemia vs No ischemia · CV mortality | 6.40 (4.48–9.14) | ||
| Prognosis: stress-inducible ischemia · mean [SD] follow-up 3.5 [2.1] years — Inducible ischemia vs No ischemia · MACE | 5.33 (4.04–7.04) | ||
| Prognosis: late gadolinium enhancement — LGE vs No LGE · all-cause mortality | 2.22 (1.99–2.47) | ||
| Prognosis: late gadolinium enhancement — LGE vs No LGE · CV mortality | 6.03 (2.76–13.13) | ||
| Prognosis: late gadolinium enhancement — LGE vs No LGE · MACE | 5.42 (3.42–8.60) | ||
| 0.050.21520Odds ratio (log scale) |
| Outcome | Values | Estimate |
|---|---|---|
| Diagnostic accuracy by subgroup | Stress CMR DOR, suspected CAD 53.4; 95% CI, 27.7-103.0 · DOR, 3-T imaging 33.2; 95% CI, 19.9-55.4 |
- Prognosis: stress-inducible ischemia: 31 prognostic studies, 67 080 individuals
Cardiovascular (CV) death after a negative test
- Pooled annualized event rates for CV death
- less than 1.0%
Original publication
Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease. JAMA Cardiol. Published 1 July 2023. doi:10.1001/jamacardio.2023.1290
Summarised from the published abstract; every number is checked against it