Stress Cardiac Magnetic Resonance Ischemia Burden and Cardiovascular Events: Post-Hoc Analysis From the ISCHEMIA Trial
Authors' conclusion
Ischemia severity by CMR had a stronger association with all ISCHEMIA trial endpoints compared with SPECT/echo.
Study context
- Population
- Patients with coronary disease and site-interpreted moderate to severe ischemia in the ISCHEMIA trial3,909 randomized
- Participants
- 313 vs 5,627
- Comparison
- Stress cardiac magnetic resonance (CMR) vs SPECT/echo
- CMRn = 313
- SPECT/echon = 5,627reference
- Primary endpoint
- CV death, nonfatal MI, or hospitalization for unstable angina, HF, or resuscitated cardiac arrest (trial primary outcome), by ischemia severity
- Follow-up
- 4 years
Methodological detailsMedian follow-up 3.37 years (Q1-Q3: 2.20-4.56 years)
- Median follow-up 3.37 years (Q1-Q3: 2.20-4.56 years)
Primary result
As reported in the abstract
4-year primary outcome rate by ischemia severity (no/mild, moderate, severe)
No/mild
Moderate
Severe
- CMR ischemia severity associated with primary outcome; SPECT/echo ischemia severity was not
- P = 0.042
Further findings
Severe ischemia
P < 0.001
Randomized
P < 0.001
Invasive referral and coronary revascularization (conservative management, no/mild ischemia) · 4 years
Invasive referral
Revascularization
CV death/myocardial infarction (MI) and nonfatal MI by CMR ischemia severity · 4 years
- CMR ischemia severity associated with CV death/MI
- P = 0.041
- CMR ischemia severity associated with nonfatal MI
- P = 0.03
- SPECT/echo ischemia severity not associated
Original publication
Stress Cardiac Magnetic Resonance Ischemia Burden and Cardiovascular Events: Post-Hoc Analysis From the ISCHEMIA Trial. JACC Cardiovasc Imaging. Published 5 December 2025. doi:10.
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