Stress CMR Perfusion Imaging in the United States (SPINS) Study (SPINS)

Inclusion Criteria:

all of the following at time of imaging: a) male or female at age 35-85 years, b) presence of either of the following sign/symptom that led to stress CMR imaging

1. Symptoms suspicious of ischemia, or

2. abnormal ECG with a suspicion of coronary artery disease c) Intermediate or high risk of significant coronary disease based on at least 2 of the following conditions:

   1. patient age > 50 for male, 60 for female
   2. Diabetes: by either history or medical treatment
   3. Hypertension: by either history or medical treatment
   4. Hypercholesterolemia: by either history or medical treatment
   5. family history of premature coronary disease: first degree relative at age <= 55 male and <=65 female
   6. Body mass index > 30
   7. Any medical documentation of peripheral artery disease
   8. Any history of myocardial infarction or percutaneous coronary intervention

Exclusion Criteria:

1. Prior history of coronary artery bypass surgery (CABG)
2. Acute myocardial infarction within the past 30 days prior to CMR
3. any significant non-coronary cardiac conditions confirmed by medical documentation a. severe valvular heart disease, b. non-ischemic cardiomyopathy with LVEF <40%, c. infiltrative cardiomyopathy, d. hypertrophic cardiomyopathy, e. pericardial disease with significant constriction, or
4. active pregnancy,
5. any competing conditions leading to an expected survival of < 2 years
6. Known inability to follow-up due to logistical reasons (e.g. patient lives in another country where follow-up is not feasible)