Stress Cardiac Magnetic Resonance (CMR) Perfusion Imaging in the Medicare-Eligible Population: Insights From the SPINS Study
Authors' conclusion
In a multicenter cohort of Medicare-eligible older patients, stress CMR was effective in providing risk stratification.
Study context
- Population
- Patients aged ≥65 years referred for stress CMR for evaluation of myocardial inducible ischemia, multicentre US registryaged 73 ± 5.7 years
- Participants
- 1,780 patients
- Exposure
- Inducible ischemia and late gadolinium enhancement (LGE) on stress CMR vs their absence
- Outcome
- Cardiovascular (CV) death or nonfatal MI
- Follow-up
- Median 4.8 years
Methodological detailsprognostic, US registry
- Prognostic
- US registry
Main finding
As reported in the abstract
Neither inducible ischemia nor LGE
<1%
annualized rate
Each group vs neither inducible ischemia nor LGEHazard ratio (95% CI)P value
Inducible ischemia
2.80(1.93–4.05)
P < 0.001LGE
1.85(1.21–2.82)
P = 0.004- Primary events
- 144
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Secondary outcome (primary outcome, hospitalization for unstable angina or congestive HF, unplanned late CABG) · median follow-up 4.8 yearsInducible ischemiavs Neither inducible ischemia nor LGEMultivariable, adjusted for CV risk factors | 2.46 (1.90–3.19) | P < 0.001 | |
| Secondary outcome (primary outcome, hospitalization for unstable angina or congestive HF, unplanned late CABG) · median follow-up 4.8 yearsLGEvs Neither inducible ischemia nor LGEMultivariable, adjusted for CV risk factors | 1.72 (1.30–2.27) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
- Secondary outcome (primary outcome, hospitalization for unstable angina or congestive HF, unplanned late CABG) — Secondary events
- 323
Revascularization and downstream costs without CMR-detected inducible ischemia
- Remained low throughout follow-up
Original publication
Stress CMR Perfusion Imaging in the Medicare-Eligible Population: Insights From the SPINS Study. JACC Cardiovasc Imaging. Published 16 October 2024. doi:10.
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