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CV MRI noninferior to FFR for MACE in patients with stable angina, CAD risk factors
Myocardial perfusion CV MRI lowered the incidence of coronary revascularization compared with fractional flow reserve in patients with stable angina and CAD risk factors, according to results from the MR-INFORM study published in The New England Journal of Medicine.
Myocardial perfusion CV MRI was noninferior to FFR for MACE, according to the study.
Patients with stable angina
Eike Nagel, MD, chair of cardiovascular imaging at Goethe University Frankfurt in Germany, and colleagues analyzed data from 918 patients from 16 sites with typical angina symptoms and either a positive exercise treadmill test or at least two CV risk factors such as diabetes, hypertension, smoking, hyperlipidemia or a family history of CAD.
Patients were assigned to CV MRI (n = 454; mean age, 62 years; 73% men), which included guideline-directed medical therapy and revascularization guided by myocardial perfusion CV MRI, or FFR (n = 464; mean age, 62 years; 72% men), which included guideline-directed medical therapy and revascularization guided by invasive angiography with FFR measurement. Revascularization was recommended for the FFR group if FFR was 0.8 or less and for the CV MRI group if ischemia was in at least 6% of the myocardium.
The primary outcome of interest was a composite of MACE, defined as all-cause death, target vessel revascularization or nonfatal MI at 12 months. The secondary outcome of interest was individual components of the primary outcome of interest.
Criteria to recommend revascularization was met by 40.5% of patients in the CV-MRI group and 45.9% in the FFR group (P = .11). Patients assigned CV MRI had lower rates of index revascularization compared with patients assigned FFR (35.7% vs. 45%; P = .005).
Primary outcome of interest
During a median follow-up of 375 days, the primary outcome of interest occurred in 3.6% of patients in the CV-MRI group vs. 3.7% of those in the FFR group, which met the noninferiority threshold (risk difference = –0.2 percentage points; 95% CI, –2.7 to 2.4; noninferiority margin = 6 percentage points).
Significant differences were not seen in the CV MRI and FFR groups for the percentage of patients free from angina at 12 months (49.2% vs. 43.8%, respectively; P = .21).
“Current guidelines on the management of the care of patients with suspected coronary artery disease separate diagnostic strategies from therapeutic strategies owing to a lack of evidence comparing combined diagnostic and therapeutic pathways,” Nagel and colleagues wrote. “The MR-INFORM trial closes this knowledge gap by comparing two frequently used, well-defined, standardized, and validated clinical management strategies. The cardiovascular-MRI methods used in this trial are readily available and can be implemented on standard MRI systems.” – by Darlene Dobkowski
Disclosures: The study was funded by the Guy’s and St. Thomas’ Biomedical Research Center of the National Institute for Health Research and the German Center for Cardiovascular Research with supplemental corporate support from Bayer. Nagel reports he received lecture fees from Bayer and Siemens Healthineers, provision of postprocessing software from Medis and consultant fees from Bayer. Please see the study for all other authors’ relevant financial disclosures.