Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry

Heydari, B; Ge, Y; Antiochos, P; Islam, S; Steel, K; Bingham, S; Abdullah, S; Mikolich, JR; Arai, AE; Bandettini, WP; Patel, AR; Shanbhag, SM; Farzaneh-Far, A; Heitner, JF; Shenoy, C; Leung, SW; Gonzalez, JA; Raman, SV; Ferrari, VA; Shah, DJ; Schulz-Menger, J; Stuber, M; Simonetti, OP; Kwong, RY

doi:10.1016/j.jcmg.2022.11.025

Coronary disease & ACS

Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry

JACC Cardiovasc ImagingPublished 8 Feb 2023Registry-based cohort study

Main finding · CV death or nonfatal MI, by sex and CMR resultResultHazard ratio 2.64 95% CI 1.20–5.90

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Authors' conclusion

Stress CMR demonstrated excellent prognostic performance with lower rates of invasive coronary angiography referral in women.

Study context

Population: Patients with suspected cardiovascular disease (CVD) undergoing stress perfusion cardiac magnetic resonance (CMR), SPINS Registry (US)1,104 women (47%)
Participants: 2,349 patients

Exposure: Women vs men; abnormal vs normal stress CMR
Womenn = 1,104
Outcome: Composite of:
CV death
Nonfatal MI
Follow-up: 5.4-year median

Methodological detailssecondary analysis of the SPINS registry, multicentre

Secondary analysis of the SPINS registry
Multicentre

Main finding

CV death or nonfatal MI, by sex and CMR result

Hazard ratio

2.64

95% CI 1.20–5.90

P = 0.02

By group

Women, normal CMR

0.54%/y

Men, normal CMR

0.75%/y

Women, abnormal CMR

3.74%/y

Abnormal stress CMRvs Normal stress CMR

HR 2.64 (95% CI 1.20–5.90); P = 0.02

As reported in the abstract

Observational data: associations, not effects.

Secondary outcomes

Outcome	← Lower risk with abnormal stress CMR ←→ Higher risk with abnormal stress CMR →	HR (95% CI)	P value
Secondary outcome (hospitalization for unstable angina or HF, late unplanned CABG)Abnormal stress CMRvs Normal stress CMRIndependent predictor	0.20.5125	2.09 (1.43–3.08)	P < 0.0001
	0.20.5125Hazard ratio (log scale)

Chest pain prevalence

P < 0.0001

Women62%

Men50%

Invasive coronary angiography · 90 days after CMR

P = 0.0001

Women3.6%

Men7.3%

Outcome	Women	Men	P value
Secondary outcome (hospitalization for unstable angina or HF, late unplanned CABG)Women, abnormal CMR vs Women, normal CMR			P < 0.0001
Downstream costs · 90 days after CMR	$114	$171	P = 0.001

Secondary outcome (hospitalization for unstable angina or HF, late unplanned CABG): Women, abnormal CMR 9.8%/y
Secondary outcome (hospitalization for unstable angina or HF, late unplanned CABG): Women, normal CMR 1.6%/y

Diagnostic image quality

No effect of sex on diagnostic image quality

Original publication

Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry. JACC Cardiovasc Imaging. Published 8 February 2023. doi:10.1016/j.jcmg.2022.11.025

Read the original article ↗

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