John P. Greenwood, MB ChB, PhD; Bernhard A. Herzog, MD; Julia M. Brown, MSc; Colin C. Everett, MSc; Jane Nixon, PhD; Petra Bijsterveld, MA; Neil Maredia, MB ChB, MD; Manish Motwani, MB ChB, PhD; Catherine J. Dickinson, BM BCh, MA, PhD; Stephen G. Ball, MB BChir, PhD; Sven Plein, MD, PhD
Acknowledgment: This study would not have been possible without the willing cooperation of the patients in West Yorkshire, United Kingdom, and the enthusiastic support of the study investigators.
Disclosures: Drs. Greenwood, Maredia, and Ball and Ms. Brown report grants from the British Heart Foundation during the conduct of the study. Dr. Plein reports speaker fees from Philips Healthcare outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1801.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available from Dr. Greenwood (e-mail, firstname.lastname@example.org). Statistical code: Available from Ms. Brown (e-mail, email@example.com). Data set: Not available.
Requests for Single Reprints: John P. Greenwood, MB ChB, PhD, Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LIGHT Building, Clarendon Way, Leeds LS2 9JT, United Kingdom; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Greenwood, Motwani, Ball, and Plein: Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LIGHT Building, Clarendon Way, Leeds LS2 9JT, United Kingdom.
Dr. Herzog: Heart Clinic Lucerne, St. Anna-Strasse 32, 6006 Lucerne, Switzerland.
Ms. Brown, Mr. Everett, and Dr. Nixon: Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Clarendon Road, Leeds LS2 9JT, United Kingdom.
Ms. Bijsterveld and Dr. Dickinson: Department of Cardiology, Old X39, Main Site, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
Dr. Maredia: Consultant Cardiologist, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom.
Author Contributions: Conception and design: J.P. Greenwood, J.M. Brown, J. Nixon, S.G. Ball, S. Plein.
Analysis and interpretation of the data: J.P. Greenwood, B.A. Herzog, J.M. Brown, C.C. Everett, J. Nixon, N. Maredia, M. Motwani, S.G. Ball, S. Plein.
Drafting of the article: J.M. Brown, N. Maredia.
Critical revision of the article for important intellectual content: J.P. Greenwood, B.A. Herzog, J.M. Brown, C.C. Everett, J. Nixon, N. Maredia, M. Motwani, S. Plein.
Final approval of the article: J.P. Greenwood, J.M. Brown, J. Nixon, N. Maredia, C.J. Dickinson, S.G. Ball, S. Plein.
Provision of study materials or patients: J.P. Greenwood, P. Bijsterveld, S.G. Ball.
Statistical expertise: J.M. Brown, C.C. Everett, S. Plein.
Obtaining of funding: J.P. Greenwood, J.M. Brown, J. Nixon, S.G. Ball, S. Plein.
Administrative, technical, or logistic support: J. Nixon, P. Bijsterveld, N. Maredia.
Collection and assembly of data: J.P. Greenwood, J.M. Brown, P. Bijsterveld, N. Maredia, M. Motwani, C.J. Dickinson, S. Plein.
There 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).
To establish the ability of CMR and SPECT to predict major adverse cardiovascular events (MACEs).
Annual 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)
Secondary and tertiary care cardiology services.
752 patients from the CE-MARC study who were being investigated for suspected CHD.
Prediction of time to MACE was assessed by using univariable (log-rank test) and multivariable (Cox proportional hazards regression) analysis.
744 (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.
Data are from a single-center observational study (albeit conducted in a high-volume institution for both CMR and SPECT).
Five-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.
British Heart Foundation.
Greenwood JP, Herzog BA, Brown JM, Everett CC, Nixon J, Bijsterveld P, et al. Prognostic Value of Cardiovascular Magnetic Resonance and Single-Photon Emission Computed Tomography in Suspected Coronary Heart Disease: Long-Term Follow-up of a Prospective, Diagnostic Accuracy Cohort Study. Ann Intern Med. ;165:1–9. doi: 10.7326/M15-1801
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Published: Ann Intern Med. 2016;165(1):1-9.
Published at www.annals.org on 10 May 2016
Cardiac Diagnosis and Imaging, Cardiology, Coronary Heart Disease, High Value Care, Hospital Medicine.
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