Regional, Artery-Specific Thresholds of Quantitative Myocardial Perfusion by PET Associated with Reduced Myocardial Infarction and Death After Revascularization in Stable Coronary Artery Disease
Autor: | David D. McPherson, Anthony L. Estrera, Sal Arain, Dejian Lai, Pranav Loyalka, Stefano Sdringola, Tom C. Nguyen, Prakash Balan, Nils P. Johnson, Biswajit Kar, Mary Haynie, Angelo Nascimbene, Igor D. Gregoric, Richard L. Kirkeeide, Hongjian Zhu, Hazem Safi, Tung Nguyen, Amanda E. Roby, K. Lance Gould, Mohammad Madjid, Richard W. Smalling, Monica B. Patel |
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Rok vydání: | 2018 |
Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Clinical Decision-Making Cardiology Myocardial Infarction Coronary Artery Disease 030204 cardiovascular system & hematology Revascularization 030218 nuclear medicine & medical imaging Coronary artery disease cardiac PET 03 medical and health sciences Clinical 0302 clinical medicine Stress Physiological Internal medicine Coronary Circulation medicine Myocardial Revascularization Humans Radiology Nuclear Medicine and imaging Myocardial infarction Stroke Aged business.industry Hazard ratio Coronary flow reserve Arteries medicine.disease Cardiac PET Organ Specificity Positron-Emission Tomography Female coronary revascularization quantitative myocardial perfusion business Perfusion |
Zdroj: | Journal of Nuclear Medicine |
ISSN: | 1535-5667 |
Popis: | 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 = 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. |
Databáze: | OpenAIRE |
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