Coronary sodium [¹⁸F]fluoride activity predicts outcomes post-CABG: a comparative evaluation with conventional metrics.

Abstract

The value of preoperative multidisciplinary approach remains inadequately delineated in forecasting postoperative outcomes of patients undergoing coronary artery bypass grafting (CABG). Herein, we aimed to ascertain the efficacy of multi-modality cardiac imaging in predicting post-CABG cardiovascular outcomes. Patients with triple coronary artery disease underwent cardiac sodium [¹⁸F]fluoride ([¹⁸F]NaF) positron emission tomography/computed tomography (PET/CT), coronary angiography, and CT-based coronary artery calcium scoring before CABG. The maximum coronary [¹⁸F]NaF activity (target-to-blood ratio [TBR]_max) and the global coronary [¹⁸F]NaF activity (TBR_global) was determined. The primary endpoint was perioperative myocardial infarction (PMI) within 7-day post-CABG. Secondary endpoint included major adverse cardiac and cerebrovascular events (MACCEs) and recurrent angina. This prospective observational study examined 101 patients for a median of 40 months (interquartile range: 19-47 months). Both TBR_max (odds ratio [OR] = 1.445; p = 0.011) and TBR_global (OR = 1.797; P = 0.018) were significant predictors of PMI. TBR_max>3.0 (area under the curve [AUC], 0.65; sensitivity, 75.0%; specificity, 56.8%; p = 0.036) increased PMI risk by 3.661-fold, independent of external confounders. Kaplan-Meier test revealed a decrease in MACCE survival rate concomitant with an escalating TBR_max. TBR_max>3.6 (AUC, 0.70; sensitivity, 76.9%; specificity, 73.9%; p = 0.017) increased MACCEs risk by 5.520-fold. Both TBR_max (hazard ratio [HR], 1.298; p = 0.004) and TBR_global (HR = 1.335; p = 0.011) were significantly correlated with recurrent angina. No significant associations were found between CAC and SYNTAX scores and between PMI occurrence and long-term MACCEs. Quantification of coronary microcalcification activity via [¹⁸F]NaF PET displayed a strong ability to predict early and long-term post-CABG cardiovascular outcomes, thereby outperforming conventional metrics of coronary macrocalcification burden and stenosis severity. The trial was registered with the Chinese Clinical Trial Committee (number: ChiCTR1900022527; URL: www.chictr.org.cn/showproj.html?proj=37933 ).