A1 Refereed original research article in a scientific journal
Prognostic Value of Coronary CT Angiography With Selective PET Perfusion Imaging in Coronary Artery Disease
Authors: Teemu Maaniitty, Iida Stenström, Jeroen J. Bax, Valtteri Uusitalo, Heikki Ukkonen, Sami Kajander, Maija Mäki, Antti Saraste, Juhani Knuuti
Publisher: Elsevier
Publication year: 2017
Journal: JACC: Cardiovascular Imaging
Journal acronym: JACC Cardiovasc Imaging
Volume: 10
Issue: 11
First page : 1361
Last page: 1370
Number of pages: 10
ISSN: 1936-878X
eISSN: 1876-7591
DOI: https://doi.org/10.1016/j.jcmg.2016.10.025(external)
OBJECTIVES:
The purpose of this study was to evaluate the prognostic value of sequential
hybrid imaging strategy in which positron emission tomography (PET) perfusion
imaging is performed selectively in patients with suspected obstructive
coronary artery disease (CAD) on coronary computed tomography angiography
(CTA).
BACKGROUND:
Coronary CTA is an accurate diagnostic test for
excluding obstructive CAD. However, the positive predictive value is suboptimal.
METHODS:
We investigated 864 consecutive symptomatic patients
with intermediate probability of CAD who adhered to the sequential imaging
approach. PET myocardial perfusion imaging using 15O-labeled water during adenosine stress was performed when suspected
obstructive stenosis was present on coronary CTA. The major adverse events
(AEs) including all-cause mortality, myocardial infarction (MI), and unstable
angina pectoris (UAP) were recorded.
RESULTS:
During a median follow-up of 3.6 years, 16 deaths, 10
MIs, and 5 UAPs occurred. Obstructive CAD was excluded by coronary CTA in 462
(53%) patients who had significantly lower annual AE rate than did patients
with suspected obstructive stenosis on coronary CTA (0.4% vs. 1.5%; p =
0.003). The latter underwent PET study, on which 195 (49%) had normal and 207
had abnormal perfusion. The annual rate of AEs was 5 times higher in those with
abnormal perfusion than with normal perfusion (2.5% vs. 0.5%; p = 0.004).
Patients with normal perfusion had AE rate comparable to patients without
obstructive CAD on coronary CTA (p = 0.77).
CONCLUSIONS:
In patients with suspected CAD obstructive disease can
be excluded in 53% of patients by coronary CTA, and these patients have
good outcome. About one-half (49%) of the remaining patients have normal
perfusion and event rate comparable to patients without obstructive
CAD on coronary CTA while patients with ischemia have clearly worse outcome.
Sequential approach utilizing anatomical imaging by coronary CTA
followed by selective functional perfusion imaging is a feasible
strategy to diagnose and risk-stratify patients with suspected CAD.
