Magnetocardiography for Exploratory Risk Stratification in Patients With Three-Vessel Coronary Artery Disease: A Single-Center Prospective Cohort Study.

BACKGROUND AND AIMS: Patients with three-vessel coronary artery disease (3V-CAD) remain at heterogeneous risk for major adverse cardiovascular and cerebrovascular events (MACCE) after revascularization. Magnetocardiography (MCG) is a noncontact and radiation-free technique that may capture electrophysiological abnormalities not reflected by anatomical risk scores. This study evaluated the exploratory prognostic value of MCG-derived parameters in patients with 3V-CAD.

METHODS

This single-center prospective cohort study included 544 patients with 3V-CAD who underwent coronary revascularization. MCG recordings were obtained before revascularization using a 36-channel optically pumped magnetometer-based system. The primary endpoint was MACCE, defined as cardiac death, stroke, myocardial infarction, or unplanned revascularization. Cox regression models were constructed using clinical variables, SYNTAX score, and an MCG composite variable. Model performance was assessed using discrimination, calibration, decision curve analysis, and bootstrap internal validation.

RESULTS

During a median follow-up of 725 days, 37 patients (6.8%) experienced MACCE. The SYNTAX score was independently associated with MACCE after adjustment for clinical variables and MCG score (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.04-1.12; p < 0.001). The MCG composite variable was also associated with MACCE after adjustment for clinical variables and SYNTAX score (HR, 2.74; 95% CI, 1.57-4.79; p < 0.001). Model discrimination increased from 0.596 for clinical variables alone to 0.682 after adding SYNTAX score and to 0.727 after adding MCG. However, the improvement from the clinical + SYNTAX model to the MCG-added model was not statistically significant (p = 0.17). Bootstrap validation showed an optimism-corrected C-index of 0.672.

CONCLUSION

MCG-derived parameters were associated with MACCE and may provide complementary electrophysiological information for exploratory risk stratification in patients with 3V-CAD after revascularization. Larger multicenter studies with external validation are needed to confirm its complementary prognostic value.

TRIAL REGISTRATION: Chinese Clinical Trial Registry identifier: ChiCTR2200066942.