22 Jun 20. Featured Paper

Link to paper on JACC Journals

Authors

Jacek Kwiecinski, Evangelos Tzolos, Philip D. Adamson, Sebastien Cadet, Alastair J. Moss, Nikhil Joshi, Michelle C. Williams, Edwin J.R. van Beek, Damini Dey, Daniel S. Berman, David E. Newby, Piotr J. Slomka & Marc R. Dweck

Abstract

Background: Reliable methods for predicting myocardial infarction in patients with established coronary artery disease are lacking.

Coronary ¹⁸F-sodium fluoride (¹⁸F-NaF) positron emission tomography (PET) provides an assessment of atherosclerosis activity.

Objectives: This study assessed whether ¹⁸F-NaF PET predicts myocardial infarction & provides additional prognostic information to current methods of risk stratification.

Methods: Patients with known coronary artery disease underwent ¹⁸F-NaF PET computed tomography & were followed up for fatal or nonfatal myocardial infarction over 42 months (interquartile range: 31 to 49 months).

Total coronary ¹⁸F-NaF uptake was determined by the coronary microcalcification activity (CMA).

Results: In a post hoc analysis of data collected for prospective observational studies, the authors studied 293 study participants (age: 65 ± 9 years; 84% men), of whom 203 (69%) showed increased coronary ¹⁸F-NaF activity (CMA >0).

Fatal or nonfatal myocardial infarction occurred only in patients with increased coronary ¹⁸F-NaF activity (20 of 203 with a CMA >0 vs. 0 of 90 with a CMA of 0; p < 0.001).

On receiver operator curve analysis, fatal or nonfatal myocardial infarction prediction was highest for ¹⁸F-NaF CMA, outperforming coronary calcium scoring, modified Duke coronary artery disease index & Reduction of Atherothrombosis for Continued Health (REACH) & Secondary Manifestations of Arterial Disease (SMART) risk scores (area under the curve: 0.76 vs. 0.54, 0.62, 0.52, & 0.54, respectively; p < 0.001 for all).

Patients with CMA >1.56 had a >7-fold increase in fatal or nonfatal myocardial infarction (hazard ratio: 7.1; 95% confidence interval: 2.2 to 25.1; p = 0.003) independent of age, sex, risk factors, segment involvement & coronary calcium scores, presence of coronary stents, coronary stenosis, REACH & SMART scores, the Duke coronary artery disease index, & recent myocardial infarction.

Conclusions: In patients with established coronary artery disease, ¹⁸F-NaF PET provides powerful independent prediction of fatal or nonfatal myocardial infarction.

Keywords

• ¹⁸F-NaF PET
• Coronary artery disease
• Coronary computed tomography
• Coronary event risk prediction
• Myocardial infarction