#VisualAbstract: Magnetic Resonance Perfusion or Fractional Flow Reserve in Coronary Disease

1. In patients with stable angina and multiple cardiac risk factors, those undergoing myocardial-perfusion cardiovascular magnetic resonance imaging (MRI) compared to invasive angiography and measurement of fractional flow reserve (FFR) underwent fewer coronary revascularization procedures.

2. Patients in the MRI group experienced major adverse cardiac events at a rate non-inferior to the FFR group.

Evidence Rating Level: 1 (Excellent)  

Study Rundown: Patients with stable angina are treated to reduce the likelihood of adverse cardiac events. Initial management is focused on risk factor reduction or medication use, but if significant coronary perfusion deficits are found revascularization procedures are recommended. Determination of perfusion deficits can be performed using invasive FFR methods or noninvasive MRI techniques, though major studies are lacking comparing the outcomes of patients evaluated by these methods. The Myocardial Perfusion CMR versus Angiography and FFR to Guide the Management of Patients with Stable Coronary Artery Disease (MR-INFORM) trial randomized patients to MRI or FFR groups and found fewer patients in the MRI group underwent coronary revascularization. The composite adverse event outcome of death or other major cardiac events occurring over 1-year following MRI or FFR occurred at a similar rate in both groups.

Strengths of this study include its randomized design, large study size, and evaluation of multiple secondary outcomes, while it is limited by its follow-up extending out to only 1 year.

Click to read the study in NEJM

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