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Observational Study
. 2025 Jan;18(1):33-44.
doi: 10.1016/j.jcmg.2024.07.029. Epub 2024 Oct 16.

Stress CMR Perfusion Imaging in the Medicare-Eligible Population: Insights From the SPINS Study

Yin Ge  1 , Panagiotis Antiochos  2 , Benedikt Bernhard  3 , Bobak Heydari  4 , Kevin Steel  5 , Scott Bingham  6 , J Ronald Mikolich  7 , Andrew E Arai  8 , W Patricia Bandettini  8 , Amit R Patel  9 , Sujata M Shanbhag  8 , Afshin Farzaneh-Far  10 , John F Heitner  11 , Chetan Shenoy  12 , Steve W Leung  13 , Jorge A Gonzalez  14 , Dipan J Shah  15 , Subha V Raman  16 , Victor A Ferrari  17 , Jeanette Schulz-Menger  18 , Matthias Stuber  19 , Orlando P Simonetti  20 , Raymond Y Kwong  21
Affiliations
Observational Study

Stress CMR Perfusion Imaging in the Medicare-Eligible Population: Insights From the SPINS Study

Yin Ge et al. JACC Cardiovasc Imaging. 2025 Jan.

Abstract

Background: Patients aged ≥65 years account for a disproportionately large portion of cardiovascular (CV) events and pose a challenge for noninvasive detection of coronary artery disease.

Objectives: This study sought to determine the prognostic value of stress cardiac magnetic resonance (CMR) in a Medicare-eligible group of patients in a multicenter setting in the United States.

Methods: From a multicenter U.S. registry, the study identified patients aged ≥65 years who were referred for stress CMR for evaluation of myocardial inducible ischemia. The primary outcome was defined as CV death or nonfatal myocardial infarction, whereas the secondary outcome was defined as any primary outcome, hospitalization for unstable angina, hospitalization for congestive heart failure, and unplanned late coronary artery bypass grafting. The associations of CMR findings with CV outcomes adjusted to clinical risk markers and health care cost spending were determined.

Results: Among 1,780 patients (aged 73 ± 5.7 years; 46% female), study investigators observed 144 primary events and 323 secondary events, over a median follow-up of 4.8 years. The presence of inducible ischemia and late gadolinium enhancement (LGE) was associated with incrementally higher event rates. Patients with neither inducible ischemia nor LGE experienced a <1% annualized rate of primary outcome. In a multivariable model adjusted for CV risk factors, inducible ischemia and LGE maintained an independent association with primary (HR: 2.80 [95% CI: 1.93-4.05]; P < 0.001; and HR: 1.85 [95% CI: 1.21-2.82]; P = 0.004, respectively) and secondary (HR: 2.46 [95% CI: 1.90-3.19]; P < 0.001; and HR: 1.72 [95% CI: 1.30-2.27]; P < 0.001, respectively) outcomes. Rates of revascularization, as well as downstream costs for patients without CMR-detected inducible ischemia, remained low throughout the follow-up period.

Conclusions: In a multicenter cohort of Medicare-eligible older patients, stress CMR was effective in providing risk stratification. (Stress CMR Perfusion Imaging in the United States [SPINS] study; NCT03192891).

Keywords: Medicare; prognosis; stress CMR.

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Conflict of interest statement

Funding Support and Author Disclosures The SPINS study of the SCMR (Society for Cardiovascular Magnetic Resonance) registry has received funding from the SCMR with a research grant jointly sponsored by Siemens Healthineers and Bayer. These sponsors have provided financial support for the study but have not played a role in study design, data collection, analysis, interpretation, or manuscript drafting. Dr Antiochos has received research funding from the Swiss National Science Foundation (grant P2LAP3_184037), the Novartis Foundation for Medical-Biological Research, the Bangerter-Rhyner Foundation, and the SICPA Foundation. Dr Bandettini has served as the principal investigator of a Bayer-sponsored GadaCAD2 (Gadavist-Enhanced Cardiac Magnetic Resonance Imaging to Detect Coronary Artery Disease) site. Dr Patel has received a research grant from and served on the Speakers Bureau of Astellas. Dr Shenoy has received support from a National Institutes of Health grant (K23HL132011). Dr Raman has received institutional research support from Siemens. Dr Schulz-Menger has had research agreements with Siemens and has served on the advisory board of Bayer. Dr Stuber has received nonmonetary research support from Siemens Healthineers. Dr Simonetti has received institutional research support from Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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