MR-INFORM

Myocardial Perfusion CMR vs Angiography and FFR to Guide Management of Stable CAD

Overview

The MR-INFORM trial was an international, multicenter, randomized controlled noninferiority outcome trial comparing two strategies for guiding revascularization decisions in patients with stable coronary artery disease.

ClinicalTrials.gov: NCT01236807

Study Design

  • Design: Prospective, multicenter, randomized, noninferiority trial
  • Sites: 16 centers in Europe and Australia
  • Enrollment: 918 patients with stable angina (CCS grade II-III) and intermediate-to-high risk of CAD
  • Randomization: 1:1 to CMR-guided vs FFR-guided management

Arms:

  1. CMR-guided: Management decisions guided by stress perfusion cardiovascular magnetic resonance imaging
  2. FFR-guided: Management decisions guided by coronary angiography and fractional flow reserve

Key Findings

At 1-year follow-up:

  • MACE rate: 3.3% (CMR) vs 3.9% (FFR) — nonsignificant difference (P = 0.62)
  • Revascularization rate: 36.0% (CMR) vs 44.2% (FFR) — P = 0.0053

Conclusion: CMR-guided management was noninferior to FFR-guided management with respect to major adverse cardiac events, despite significantly fewer revascularizations.

Publication

Nagel E, Greenwood JP, McCann GP, Bettencourt N, Shah AM, Hussain ST, Perera D, Plein S, et al. for the MR-INFORM Investigators. Magnetic Resonance Perfusion or Fractional Flow Reserve in Coronary Disease. N Engl J Med 2019;380:2418-2428.

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Funding

  • Guy’s and St. Thomas’ Biomedical Research Centre, National Institute for Health Research (UK)
  • Additional support from participating institutions

Principal Investigators

  • Prof. Eike Nagel, MD, PhD — Goethe University Frankfurt
  • Prof. John Greenwood — University of Leeds
  • Prof. Sven Plein — University of Leeds