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CV MRI Noninferior to Invasive Angiography + FFR in Stable CAD

WEDNESDAY, June 19, 2019 -- Myocardial-perfusion cardiovascular magnetic resonance imaging (MRI) is noninferior to invasive angiography and fractional flow reserve (FFR) for guiding coronary revascularization in patients with stable angina and risk factors for coronary artery disease, according to a study published in the June 20 issue of the New England Journal of Medicine.

Eike Nagel, M.D., from the University Hospital Frankfurt in Germany, and colleagues randomly assigned 918 patients with typical angina and either two or more cardiovascular risk factors or a positive exercise treadmill test to a cardiovascular MRI-based or an FFR-based strategy (454 and 464 patients, respectively). The primary outcome was a composite of death, nonfatal myocardial infarction, or target-vessel revascularization within 12 months.

The researchers found that 40.5 and 45.9 percent of patients in the cardiovascular-MRI and in the FFR groups, respectively, met the criteria to recommend revascularization (P = 0.011). Compared with patients in the FFR group, fewer patients in the cardiovascular-MRI group underwent index revascularization (35.7 versus 45.0 percent; P = 0.005). The primary outcome occurred in 3.6 and 3.7 percent of patients in the cardiovascular-MRI and FFR groups, respectively, which met the noninferiority threshold (risk difference, −0.2 percent; 95 percent confidence interval, −2.7 to 2.4). There was no significant difference between the groups in the percentage of patients free from angina at 12 months (49.2 and 43.8 percent, respectively; P = 0.21).

"An initial management strategy guided by myocardial-perfusion cardiovascular MRI was noninferior to a strategy of invasive angiography and FFR," the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical technology industries.

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Posted: June 2019

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