• John P Greenwood, Bernhard A Herzog, Julia M Brown, Colin C Everett, Jane Nixon, Petra Bijsterveld, Neil Maredia, Manish Motwani, Catherine J Dickinson, Stephen G Ball, and Sven Plein.
• Ann. Intern. Med. 2016 Jul 5; 165 (1): 1-9.

BackgroundThere are no prospective, prognostic data comparing cardiovascular magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) in the same population of patients with suspected coronary heart disease (CHD).ObjectiveTo establish the ability of CMR and SPECT to predict major adverse cardiovascular events (MACEs).DesignAnnual follow-up of the CE-MARC (Clinical Evaluation of MAgnetic Resonance imaging in Coronary heart disease) study for a minimum of 5 years for MACEs (cardiovascular death, acute coronary syndrome, unscheduled revascularization or hospital admission for cardiovascular cause). (Current Controlled Trials registration: ISRCTN77246133).SettingSecondary and tertiary care cardiology services.Participants752 patients from the CE-MARC study who were being investigated for suspected CHD.MeasurementsPrediction of time to MACE was assessed by using univariable (log-rank test) and multivariable (Cox proportional hazards regression) analysis.Results744 (99%) of the 752 recruited patients had complete follow-up. Of 628 who underwent CMR, SPECT, and the reference standard test of X-ray angiography, 104 (16.6%) had at least 1 MACE. Abnormal findings on CMR (hazard ratio, 2.77 [95% CI, 1.85 to 4.16]; P < 0.001) and SPECT (hazard ratio, 1.62 [CI, 1.11 to 2.38; P = 0.014) were both strong and independent predictors of MACE. Only CMR remained a significant predictor after adjustment for other cardiovascular risk factors, angiography result, or stratification for initial patient treatment.LimitationData are from a single-center observational study (albeit conducted in a high-volume institution for both CMR and SPECT).ConclusionFive-year follow-up of the CE-MARC study indicates that compared with SPECT, CMR is a stronger predictor of risk for MACEs, independent of cardiovascular risk factors, angiography result, or initial patient treatment. This further supports the role of CMR as an alternative to SPECT for the diagnosis and management of patients with suspected CHD.Primary Funding SourceBritish Heart Foundation.

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