Impact of coronary revascularization guided by stress CMR in primary prevention

Thursday, February 5, 2026

8:10 AM - 8:20 AM

Location: Asia IV and Hall 8 (3rd Floor)

Presenting Author(s)

Theo Pezel, MD, PhD

Cardiologist
Hôpital Lariboisière – APHP, Paris, France
Paris, Ile-de-France, France

Primary Author(s)

Theo Pezel, MD, PhD

Cardiologist
Hôpital Lariboisière – APHP, Paris, France
Paris, Ile-de-France, France

Co-Author(s)

AL

Antoine Lequipar, MD

Cardiologist
Lariboisiere Hospital, France
PG

Philippe Garot, MD

Cardiologist
Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300, Massy, France, France
SD

Suzanne DUHAMEL, MD

Cardiologist
Institut Cardiovasculaire Paris Sud
Massy, Ile-de-France, France
FS

Francesca Sanguineti, MD

Cardiologist
Institut Cardiovasculaire Paris Sud, France
ST

Solenn Toupin, PhD

Clinical scientist
Siemens Healthineers
Bordeaux, Aquitaine, France
Trecy Gonçalves, MD

Cardiologist
Lariboisière Hospital – APHP, Paris, France.
PALAISEAU, Ile-de-France, France
AU

Alexandre Unger, MD

Cardiologist
Hôpital Lariboisière AP-HP
Paris, Ile-de-France, France
Julien HUDELO, MD

Cardiologist
Centre Hospitalier Universitaire Amiens Picardie
Amiens, Picardie, France
VB

Valérie Bousson, MD, PhD

Radiologist
Lariboisière Hospital – APHP, Paris, France., France
JD

Jean Guillaume Dillinger, MD, PhD

Cardiologist
Lariboisière Hospital – APHP, Paris, France., France
JG

Jérome Garot, MD, PhD

Cardiologist
Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300, Massy, France, France

Background: To assess the long-term prognostic impact of coronary revascularization after cardiovascular magnetic resonance (CMR) on all-cause mortality in consecutive patients without any history of cardiovascular disease undergoing primary prevention from a multicentric study.

Methods: From 2008 to 2024, we included all consecutive patients who underwent stress CMR for primary prevention without history of cardiovascular disease in three centers in France. Inducible ischemia was defined as a subendocardial or transmural perfusion defect that (1) occurred in at least one myocardial segment, (2) persisted for at least three phases beyond peak contrast enhancement, (3) followed a coronary distribution, and (4) in the absence of colocation with late gadolinium enhancement (LGE). Coronary revascularization after stress CMR was defined as any percutaneous coronary intervention or CABG performed within 90 days following stress CMR. The primary outcome was all-cause mortality using the electronic French National Registry of All-cause mortality (INSEE). Cox regressions analyses were performed to determine the prognostic value of myocardial ischemia and revascularization guided by stress CMR.

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 3-11 years), 2,102 deaths (5.7%) occurred. Inducible ischemia was detected in 5,232 patients (14.2%) referred for primary prevention stress-CMR and revascularization was performed in 4,661 patients (89%) (Figure 1). Patient who underwent revascularization after stress CMR were younger (63±12 vs 64±12 years), but had similar traditional cardiovascular risk factors, LVEF and number of inducible ischemic segments (all p-value=0.8). After adjustment for traditional prognosticators, inducible ischemia was an independent predictor of mortality (hazard ratio [HR] 3.72, 95% confidence interval [CI] 3.18-4.35, p< 0.001). In multivariable analysis of patients with inducible ischemia, revascularization after stress CMR was an independent predictor of improved survival in the ischemic population (HR 0.32; 95% CI, 0.26–0.39, p< 0.001) after adjustment for age, gender, traditional cardiovascular risk factors, center, chronic kidney disease, peripheral atheroma presence, history of heart failure, history of atrial fibrillation, stress CMR indication, number of inducible ischemic segments and LGE presence. Revascularization after stress CMR was associated with a significantly improved survival rate in patients with a low amount of inducible ischemia (1-4 segments) and in patients with a high inducible amount of ischemia (5-8 segments) (HR 0.29; 99% CI 0.20-0.41, p< 0.001 and OR 0.21; 99% CI 0.15-0.30, p< 0.001 respectively, Figure 2).

Conclusion: In this multicenter registry of consecutive patients in primary prevention without any history of cardiovascular disease referred for stress CMR, revascularization was associated with a lower rate of all-cause mortality.

Table 1. Multivariable Cox analysis for all-cause mortality only in patients with ischemia detected on stress CMR (Nf5,232).

Variables	Unadjusted		Model 1		Model 2
	Unadjusted		(Known risk factors)		(Stepwise)
	HR (99% CI)	p-value	HR (99% CI)	p-value	HR (99% CI)	p-value
Age	1.04 (1.03-1.05)	< 0.001	1.03 (1.02-1.05)	< 0.001	1.03 (1.02-1.04)	< 0.001
Male	1.08 (0.84-1.39)	0.41	1.16 (0.90-1.49)	0.14
BMI	0.99 (0.97-1.02)	0.49	0.99 (0.96-1.01)	0.22
Dyslipidaemia	1.36 (1.07-1.72)	0.001	1.17 (0.91-1.15)	0.11	1.19 (0.92-1.53)	0.08
Diabetes	1.44 (1.12-1.84)	< 0.001	1.23 (0.94-1.62)	0.053	1.20 (0.92-1.57)	0.09
Hypertension	1.87 (1.45-2.41)	< 0.001	1.71 (1.32-2.25)	< 0.001	1.71 (1.31-2.23)	< 0.001
Current or former smoking	1.11 (0.76-1.62)	0.49	1.16 (0.79-1.71)	0.33	1.05 (0.71-1.56)	0.74
Family history of CAD	1.33 (0.98-1.81)	0.016	1.28 (0.94-1.76)	0.046	1.34 (0.98-1.84)	0.02
Chronic kidney disease*	7.71 (5.28-11.3)	< 0.001	3.45 (2.30-5.18)	< 0.001	2.88 (1.89-4.38)	< 0.001
Peripheral atheroma	1.39 (0.91-2.13)	0.044	0.96 (0.62-1.50)	0.83
History of heart failure	4.14 (2.73-6.29)	< 0.001	1.59 (1.02-2.50)	0.011	1.44 (0.91-2.30)	0.050
History of atrial fibrillation	3.12 (1.99-4.88)	< 0.001	2.49 (1.57-2.50)	< 0.001	2.08 (1.30-3.32)	< 0.001
Symptoms^†	1.07 (0.84-1.36)	0.48	1.15 (0.90-1.47)	0.15	1.21 (0.95-1.56)	0.047
LVEF	0.94 (0.94-0.95)	< 0.001	0.95 (0.94-0.96)	< 0.001	0.96 (0.95-0.96)	< 0.001
LVEDV	1.00 (1.00-1.00)	0.19	1.00 (1.00-1.00)	0.93
LGE presence	0.66 (0.52-0.85)	< 0.001	0.77 (0.60-1.00)	0.009	0.76 (0.59-0.98)	0.005
Per 1 additional ischaemic segment	1.37 (1.30-1.44)	< 0.001			1.28 (1.21-1.35)	< 0.001
RV dysfunction	8.25 (5.18-13.1)	< 0.001			1.76 (1.06-2.92)	0.007
Revascularisation	0.24 (0.19-0.31)	< 0.001	0.29 (0.23-0.37)	< 0.001	0.32 (0.24-0.41)	< 0.001

Table 2. Incremental prognostic value of coronary revascularisation guided by stress CMR to predict all-cause mortality above traditional prognostic factors in patients with inducible ischaemia (Nf5,232).

	C-index	X²	LR Test	NRI	IDI
Model A: Traditional risk factors	0.78 (0.74-0.81)	617.0	< 0.001	Ref.	Ref.
Model B: Model A + revascularisation stratified by ischaemia extent	0.84 (0.81-0.87)	765.4	< 0.001	0.07 (0.05–0.10)	0.33 (0.29–0.40)

Model A includes traditional clinical and imaging predictors: age, sex, BMI, dyslipidaemia, diabetes, hypertension, smoking status, family history of CAD, symptoms, CKD, and LVEF. Model B includes all covariates from Model 1 plus revascularisation stratified by the extent of ischaemia.

Model performance was assessed using C-index, LR test, NRI, and IDI. All improvements were statistically significant at α = 0.01.
Figure 1. Impact of coronary revascularization guided by stress-CMR
Figure 2. Prognostic value of revascularization according to ischemic extent (N=5,232).
Figure 3. Kaplan–Meier survival curves according to revascularisation status in patients with stress CMR-detected ischaemia after propensity score matching.