TY - JOUR
T1 - Regional, artery-specific thresholds of quantitative myocardial perfusion by PET associated with reduced myocardial infarction and death after revascularization in stable coronary artery disease
AU - Lance Gould, K.
AU - Johnson, Nils P.
AU - Roby, Amanda E.
AU - Nguyen, Tung
AU - Kirkeeide, Richard
AU - Haynie, Mary
AU - Lai, Dejian
AU - Zhu, Hongjian
AU - Patel, Monica B.
AU - Smalling, Richard
AU - Arain, Sal
AU - Balan, Prakash
AU - Nguyen, Tom
AU - Estrera, Anthony
AU - Sdringola, Stefano
AU - Madjid, Mohammad
AU - Nascimbene, Angelo
AU - Loyalka, Pranav
AU - Kar, Biswajit
AU - Gregoric, Igor
AU - Safi, Hazem
AU - McPherson, David
N1 - Publisher Copyright:
COPYRIGHT © 2019 by the Society of Nuclear Medicine and Molecular Imaging.
PY - 2019
Y1 - 2019
N2 - Because randomized coronary revascularization trials in stable coronary artery disease (CAD) have shown no reduced myocardial infarction (MI) or mortality, the threshold of quantitative myocardial perfusion severity was analyzed for association with reduced death, MI, or stroke after revascularization within 90 d after PET. Methods: In a prospective long-term cohort of stable CAD, regional, artery-specific, quantitative myocardial perfusion by PET, coronary revascularization within 90 d after PET, and all-cause death, MI, and stroke (DMS) at 9-y follow-up (mean ± SD, 3.0 ± 2.3 y) were analyzed by multivariate Cox regression models and propensity analysis. Results: For 3,774 sequential rest–stress PET scans, regional, artery-specific, severely reduced coronary flow capacity (CFC) (coronary flow reserve # 1.27 and stress perfusion # 0.83 cc/min/g) associated with 60% increased hazard ratio for major adverse cardiovascular events and 30% increased hazard of DMS that was significantly reduced by 54% associated with revascularization within 90 d after PET (P 5 0.0369), compared with moderate or mild CFC, coronary flow reserve, other PET metrics or medical treatment alone. Depending on severity threshold for statistical certainty, up to 19% of this clinical cohort had CFC severity associated with reduced DMS after revascularization. Conclusion: CFC by PET provides objective, regional, artery-specific, size–severity physiologic quantification of CAD severity associated with high risk of DMS that is significantly reduced after revascularization within 90 d after PET, an association not seen for moderate to mild perfusion abnormalities or medical treatment alone.
AB - Because randomized coronary revascularization trials in stable coronary artery disease (CAD) have shown no reduced myocardial infarction (MI) or mortality, the threshold of quantitative myocardial perfusion severity was analyzed for association with reduced death, MI, or stroke after revascularization within 90 d after PET. Methods: In a prospective long-term cohort of stable CAD, regional, artery-specific, quantitative myocardial perfusion by PET, coronary revascularization within 90 d after PET, and all-cause death, MI, and stroke (DMS) at 9-y follow-up (mean ± SD, 3.0 ± 2.3 y) were analyzed by multivariate Cox regression models and propensity analysis. Results: For 3,774 sequential rest–stress PET scans, regional, artery-specific, severely reduced coronary flow capacity (CFC) (coronary flow reserve # 1.27 and stress perfusion # 0.83 cc/min/g) associated with 60% increased hazard ratio for major adverse cardiovascular events and 30% increased hazard of DMS that was significantly reduced by 54% associated with revascularization within 90 d after PET (P 5 0.0369), compared with moderate or mild CFC, coronary flow reserve, other PET metrics or medical treatment alone. Depending on severity threshold for statistical certainty, up to 19% of this clinical cohort had CFC severity associated with reduced DMS after revascularization. Conclusion: CFC by PET provides objective, regional, artery-specific, size–severity physiologic quantification of CAD severity associated with high risk of DMS that is significantly reduced after revascularization within 90 d after PET, an association not seen for moderate to mild perfusion abnormalities or medical treatment alone.
KW - Cardiac PET
KW - Coronary revascularization
KW - Quantitative myocardial perfusion
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U2 - 10.2967/jnumed.118.211953
DO - 10.2967/jnumed.118.211953
M3 - Article
C2 - 30115688
AN - SCOPUS:85063280098
SN - 0161-5505
VL - 60
SP - 410
EP - 417
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 3
ER -