Regional, artery-specific thresholds of quantitative myocardial perfusion by PET associated with reduced myocardial infarction and death after revascularization in stable coronary artery disease

K. Lance Gould, Nils P. Johnson, Amanda E. Roby, Tung Nguyen, Richard Kirkeeide, Mary Haynie, Dejian Lai, Hongjian Zhu, Monica B. Patel, Richard Smalling, Sal Arain, Prakash Balan, Tom Nguyen, Anthony Estrera, Stefano Sdringola, Mohammad Madjid, Angelo Nascimbene, Pranav Loyalka, Biswajit Kar, Igor GregoricHazem Safi, David McPherson

Research output: Contribution to journalArticlepeer-review

75 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)410-417
Number of pages8
JournalJournal of Nuclear Medicine
Volume60
Issue number3
DOIs
StatePublished - 2019

Keywords

  • Cardiac PET
  • Coronary revascularization
  • Quantitative myocardial perfusion

ASJC Scopus subject areas

  • General Medicine

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