Revascularization in patients with stable angina is often guided by either myocardial-perfusion cardiovascular MRI or invasive angiography to measure fractional flow reserve (FFR). The unblinded, multicentre MR-INFORM trial was designed to compare these two approaches. A total of 918 patients with typical angina and cardiovascular risk factors were randomly assigned to cardiovascular MRI or measurement of FFR. In the cardiovascular MRI group, 40.5% of patients met the criteria to undergo revascularization (ischaemia in ≥6% of the myocardium), whereas 45.9% of patients in the FFR group met the revascularization criteria (FFR ≤0.8). Fewer patients in the cardiovascular MRI group than in the FFR group underwent index revascularization (35.7% versus 45.0%; P = 0.005). The primary composite outcome (death, nonfatal myocardial infarction or target-vessel revascularization within 1 year) occurred in 3.6% of patients in the cardiovascular MRI group and 3.7% of patients in the FFR group, which met the threshold for noninferiority of cardiovascular MRI compared with FFR.
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Nagel, E. et al. Magnetic resonance perfusion or fractional flow reserve in coronary disease. N. Engl. J. Med. 380, 2418–2428 (2019)
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Lim, G.B. Cardiovascular MRI versus FFR in stable angina. Nat Rev Cardiol 16, 516 (2019). https://doi.org/10.1038/s41569-019-0236-8
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DOI: https://doi.org/10.1038/s41569-019-0236-8