Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men due to a lack of early diagnosis and management. Numerous clinical studies have shown the interest of stress cardiovascular magnetic resonance (CMR). However, long-term prognosis data are limited.

The aim of this study was to test the hypothesis that stress perfusion CMR imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men.

Consecutive patients referred for vasodilator stress perfusion CMR with dipyridamole were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular death or non-fatal myocardial infarction. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE).

Of 3436 patients referred for stress CMR in a single French center, 3322 (97 %) completed the CMR protocol (59.9±11.8 years, 57 % men), and among those 3033 (91 %) completed the follow-up (median follow-up 5.4±0.2 years). Stress CMR was well tolerated without severe adverse event. Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE for both women (hazard ratio HR 2.36; 95 % confidence interval CI: 1.54–3.62; P<0.001) and men (HR 3.57; 95 % confidence interval CI: 2.75–4.64; P<0.001) (Figure 1). In a multivariable stepwise Cox regression including clinical characteristics and CMR, inducible ischemia was an independent predictor of a higher incidence of MACE for both women (hazard ratio HR 1.85; 95 % confidence interval CI: 1.18–2.92; P=0.008) and men (HR 3.55; 95 % confidence interval CI: 2.73–4.63; P<0.001).

Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients of either sex presenting with inducible ischemia.