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

IF 8.6 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Nuclear Medicine and Molecular Imaging Pub Date : 2024-09-01 Epub Date: 2024-05-11 DOI:10.1007/s00259-024-06736-4

Mingxin Gao, Wanwan Wen, Haiyang Li, Yaqi Zheng, Mingkai Yun, Jingjing Meng, Shipan Wang, Bolin Wang, Biao Hu, Tiantian Mou, Yang Yu, Xiaoli Zhang, Xiang Li

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引用次数: 0

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Trial registration: The trial was registered with the Chinese Clinical Trial Committee (number: ChiCTR1900022527; URL: www.chictr.org.cn/showproj.html?proj=37933 ).

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冠状动脉钠[18F]氟化物活性预测心血管造影术后的预后：与传统指标的比较评估。

目的：术前多学科方法在预测冠状动脉旁路移植术（CABG）患者术后预后方面的价值仍未得到充分阐明。在此，我们旨在确定多模态心脏成像在预测 CABG 术后心血管预后方面的有效性：方法：三重冠状动脉疾病患者在接受 CABG 手术前接受心脏[18F]氟化钠（[18F]NaF）正电子发射断层扫描/计算机断层扫描（PET/CT）、冠状动脉造影和基于 CT 的冠状动脉钙化评分。测定了最大冠状动脉[18F]NaF活性（靶血比[TBR]max）和全冠状动脉[18F]NaF活性（TBRglobal）。主要终点是ABG术后7天内的围手术期心肌梗死（PMI）。次要终点包括主要不良心脑血管事件（MACCE）和复发性心绞痛：这项前瞻性观察研究对 101 名患者进行了中位 40 个月（四分位间范围：19-47 个月）的观察。TBRmax（比值比 [OR] = 1.445；P = 0.011）和TBRglobal（比值比 = 1.797；P = 0.018）均可显著预测PMI。TBRmax>3.0（曲线下面积 [AUC]，0.65；灵敏度，75.0%；特异度，56.8%；P = 0.036）使 PMI 风险增加 3.661 倍，不受外部混杂因素影响。Kaplan-Meier 检验显示，随着 TBRmax 的升高，MACCE 存活率也随之降低。TBRmax>3.6（AUC，0.70；灵敏度，76.9%；特异度，73.9%；p = 0.017）使 MACCEs 风险增加了 5.520 倍。TBRmax（危险比 [HR]，1.298；p = 0.004）和TBRglobal（HR = 1.335；p = 0.011）均与复发性心绞痛显著相关。CAC和SYNTAX评分之间以及PMI发生率和长期MACCE之间均未发现明显关联：结论：通过[18F]NaF PET对冠状动脉微钙化活性进行定量分析，显示出预测CABG术后早期和长期心血管预后的强大能力，从而优于冠状动脉大钙化负担和狭窄严重程度的传统指标：该试验已在中国临床试验委员会注册（编号：ChiCTR1900022527；网址：www.chictr.org.cn/showproj.html?proj=37933 ）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Nuclear Medicine and Molecular Imaging 医学-核医学

CiteScore

15.60

自引率

9.90%

发文量

392

审稿时长

3 months

期刊介绍： The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.

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