Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
J Am Coll Cardiol. 2020 Jun 23;75(24):3061-3074. doi: 10.1016/j.jacc.2020.04.046.
Reliable methods for predicting myocardial infarction in patients with established coronary artery disease are lacking. Coronary F-sodium fluoride (F-NaF) positron emission tomography (PET) provides an assessment of atherosclerosis activity.
This study assessed whether F-NaF PET predicts myocardial infarction and provides additional prognostic information to current methods of risk stratification.
Patients with known coronary artery disease underwent F-NaF PET computed tomography and were followed up for fatal or nonfatal myocardial infarction over 42 months (interquartile range: 31 to 49 months). Total coronary F-NaF uptake was determined by the coronary microcalcification activity (CMA).
In a post hoc analysis of data collected for prospective observational studies, the authors studied 293 study participants (age: 65 ± 9 years; 84% men), of whom 203 (69%) showed increased coronary F-NaF activity (CMA >0). Fatal or nonfatal myocardial infarction occurred only in patients with increased coronary F-NaF activity (20 of 203 with a CMA >0 vs. 0 of 90 with a CMA of 0; p < 0.001). On receiver operator curve analysis, fatal or nonfatal myocardial infarction prediction was highest for F-NaF CMA, outperforming coronary calcium scoring, modified Duke coronary artery disease index and Reduction of Atherothrombosis for Continued Health (REACH) and Secondary Manifestations of Arterial Disease (SMART) risk scores (area under the curve: 0.76 vs. 0.54, 0.62, 0.52, and 0.54, respectively; p < 0.001 for all). Patients with CMA >1.56 had a >7-fold increase in fatal or nonfatal myocardial infarction (hazard ratio: 7.1; 95% confidence interval: 2.2 to 25.1; p = 0.003) independent of age, sex, risk factors, segment involvement and coronary calcium scores, presence of coronary stents, coronary stenosis, REACH and SMART scores, the Duke coronary artery disease index, and recent myocardial infarction.
In patients with established coronary artery disease, F-NaF PET provides powerful independent prediction of fatal or nonfatal myocardial infarction.
目前缺乏可靠的方法来预测已确诊冠心病患者的心肌梗死。冠状动脉 F-氟化钠（F-NaF）正电子发射断层扫描（PET）可评估动脉粥样硬化的活性。
本研究评估 F-NaF PET 是否可预测心肌梗死，并为目前的风险分层方法提供额外的预后信息。
已知患有冠状动脉疾病的患者接受 F-NaF PET 计算机断层扫描，并在 42 个月（四分位距：31 至 49 个月）的时间内进行致命或非致命性心肌梗死的随访。通过冠状动脉微钙化活性（CMA）确定总冠状动脉 F-NaF 摄取。
在为前瞻性观察研究收集的数据的事后分析中，作者研究了 293 名研究参与者（年龄：65 ± 9 岁；84%为男性），其中 203 名（69%）显示冠状动脉 F-NaF 活性增加（CMA>0）。致命或非致命性心肌梗死仅发生在冠状动脉 F-NaF 活性增加的患者中（203 名 CMA>0 患者中有 20 例，而 90 名 CMA 为 0 的患者中无 1 例；p<0.001）。在接收器操作特征曲线分析中，F-NaF CMA 对致命或非致命性心肌梗死的预测最高，优于冠状动脉钙评分、改良杜克冠状动脉疾病指数和动脉疾病的持续健康（REACH）及二级表现（SMART）风险评分（曲线下面积：0.76 比 0.54、0.62、0.52 和 0.54，p<0.001）。CMA>1.56 的患者致命或非致命性心肌梗死的风险增加了 7 倍以上（危险比：7.1；95%置信区间：2.2 至 25.1；p=0.003），与年龄、性别、危险因素、节段受累和冠状动脉钙评分、冠状动脉支架置入、冠状动脉狭窄、REACH 和 SMART 评分、杜克冠状动脉疾病指数和近期心肌梗死无关。
在已确诊的冠心病患者中，F-NaF PET 可提供致命或非致命性心肌梗死的强大独立预测。
