Impact of coronary revascularisation in patients undergoing stress cardiovascular magnetic resonance in primary prevention

Abstract Background The impact of coronary revascularisation after stress cardiovascular magnetic resonance (CMR) in patients with no prior cardiovascular history remains controversial. Purpose To evaluate the long-term prognostic impact of coronary revascularisation after stress CMR on all-cause mortality in all consecutive primary prevention patients without prior cardiovascular disease from a multicentre study. Methods From 2008 to 2022, all consecutive patients undergoing stress CMR for primary prevention, without prior cardiovascular disease, were included from three French centres. The primary outcome was all-cause mortality ascertained through the French National Registry of Death. Cox regression analyses were performed to determine the prognostic value of myocardial ischaemia and stress CMR guided revascularisation. Results A total of 36,778 patients were included (mean age 64±12 years, 68% male). Over a median follow-up of 7.2 years (interquartile range [IQR 3-11 years), 2,102 deaths (5.7%) occurred. Inducible ischaemia was detected in 5,232 (14.2%) patients referred for primary prevention stress-CMR, of whom 4,661 (89%) underwent coronary revascularisation (Figure 1A). Patients who underwent revascularisation after stress CMR were younger (63 vs 64 years), but had similar traditional cardiovascular risk factors, LVEF and number of inducible ischaemic segments. After adjustment for traditional prognosticators, inducible ischaemia was an independent predictor of mortality (hazard ratio [HR] 3.72, 95% confidence interval [CI] 3.18-4.35, p