Stress MRI Cuts Adverse Events Acute Chest Pain Patients

Patients with acute chest pain admitted to the emergency department for observation do better when monitored by stress cardiac magnetic resonance (CMR) imaging, according to a small study published ahead of print online in JACC: Cardiovascular Imaging.

Physicians at Wake Forest Baptist Medical Center sought to determine if there would be an effect on revascularization, hospital readmission, and recurrent cardiac testing on patients admitted in the emergency department observation unit for complaints of acute chest pain.

A total of 105 intermediate-risk patients who presented with symptoms of acute coronary syndrome (ACS) participated in the study. They ranged in age from 35 to 91 (median age 56). Fifty-four percent were men. Twenty percent of all patients had pre-existing coronary disease. All patients were randomized to usual care provided by cardiologists and internists (53 patients) or to observation care with stress CMR (52) on the basis of the first electrocardiogram and troponin levels.

The researchers found that the index hospital admission was avoided in 85 percent of the observation CMR participants. The primary outcome occurred in 38 percent of the usual care participants versus 13 percent of the observation CMR participants. It was noted that the observation CMR group experienced significant reductions in all components: revascularizations (15 percent versus 2 percent), hospital readmissions (23 percent versus 8 percent), and recurrent cardiac testing (17 percent versus 4 percent).

The median length of stay was 26 hours for the usual care group, compared with 21 hours for the observation CMR group, and ACS after discharge happened in three patients in the usual care group but in none of the observation CMR patients.

The authors pointed out that this study was built on previous research findings that more complex patients managed in an observation unit with stress CMR testing experienced a reduction in care costs of about $2,100 per patient per year.

“What’s exciting about this is not only can we reduce events that are important to patients, but we can reduce costs as well,” lead author Chadwick Miller, MD, MS, said in a release. “What we think is happening is that the cardiac MRI is more accurately selecting patients who will benefit the most from having invasive procedures done. It’s a win-win.”