Long term prognostic value of coronary atherosclerotic burden, myocardial perfusion and coronary flow capacity by ⁸²Rb PET in patients with and without known coronary artery disease.

Abstract

We assessed the long-term prognostic value of the combined evaluation coronary atherosclerotic burden, myocardial perfusion coronary and flow capacity (CFC) derived from ⁸²Rb positron emission tomography (PET)/computed tomography (CT), in a large cohort of patients with suspected or known coronary artery disease (CAD). We studied 5285 patients with suspected or known CAD who underwent to stress/rest cardiac ⁸²Rb PET/CT imaging. Coronary artery calcium (CAC) scores were calculated and categorized as < 400 and ≥ 400. Stress TPD was considered abnormal when ≥ 5%. Baseline and hyperemic MBF were calculated. MFR was obtained and considered reduced when < 2. According to previously defined thresholds CFC was calculated. The outcome endpoints were cardiac death, myocardial infarction, and revascularization procedures whichever occurred first. During a mean time of 43 ± 26 months, 683 events occurred (13% cumulative event rate, with an AER of 2.9% person-years). The events were 127 (19%) cardiac death, 250 (37%) myocardial infarction and 306 (45%) coronary revascularizations. In patients with previous history of CAD angina, stress TPD, MFR and CFC resulted predictors of events (all P < 0.001). Differently, in patients without CAD diabetes, CAC score ≥ 400, stress TPD ≥ 5%, MFR < 2 and impaired CFC resulted as independent predictors. Weibull analysis showed that patients with known CAD, stress TPD ≥ 5%, MFR < 2 and impaired CFC had the highest probability of events. The combined evaluation of myocardial perfusion and CFC can predict outcome in both patients with and without known CAD.