Zhang Feifei, Yang Xiaoyu, Chen Yongjun, Shao Xiaoliang, Wang Jianfeng, Zhang Sheng, Shi Guiliang, Yang Minfu, Wu Zhifang, Li Sijin, Wang Yuetao
Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China; Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China; Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu Province, China.
Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
J Nucl Cardiol. 2024 Dec;42:102051. doi: 10.1016/j.nuclcard.2024.102051. Epub 2024 Oct 4.
The additional prognostic value of positron emission tomography (F-FDG PET) myocardial ischemic memory imaging for patients with suspected unstable angina (UA) is not well established. This study aimed to determine whether F-FDG PET imaging provides incremental prognostic information for predicting major adverse cardiac events (MACEs) compared to clinical risk factors, Global Registry of Acute Coronary Events (GRACE) score, and coronary artery calcium score (CACS) in patients with suspected UA.
In this post hoc analysis of a prospective study, 265 patients suspected with UA (62.3% male, mean age: 65.0±9.4 years) were enrolled. F-FDG positivity was defined as focal or focal on diffuse uptake patterns. MACEs included cardiovascular death, acute myocardial infarction, heart failure, rehospitalization for UA, and stroke. Multivariable Cox regression was used to identify predictors of MACEs, and the incremental prognostic value of F-FDG PET imaging was assessed using the Concordance Index (C-index), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
Over a median follow-up of 25 months, 51 patients (19.2%) experienced MACEs. F-FDG positivity (hazard ratio [HR]=3.220, 95% confidence interval [CI]: 1.630-6.360, P<.001), as well as F-FDG standardized uptake ratio (HR=1.330, 95% CI: 1.131-1.564, P=.0006) and Extent (HR=1.045, 95% CI: 1.028-1.062, P<.0001), were independent predictors of MACE. The addition of F-FDG PET imaging significantly improved risk stratification beyond clinical factors, the GRACE score, and CACS, with improved C-index (.769 vs .688, P=.045), NRI (.324, P=.020), and IDI (.055, P=.027).
F-FDG PET myocardial ischemic memory imaging significantly improves prognostic assessment for patients with suspected UA, providing valuable additional risk stratification beyond clinical risk factors, GRACE score, and CACS.
正电子发射断层扫描（F-FDG PET）心肌缺血记忆成像对疑似不稳定型心绞痛（UA）患者的额外预后价值尚未明确。本研究旨在确定与临床危险因素、急性冠状动脉事件全球注册（GRACE）评分和冠状动脉钙化积分（CACS）相比，F-FDG PET成像在预测疑似UA患者的主要不良心脏事件（MACE）方面是否能提供额外的预后信息。
在这项前瞻性研究的事后分析中，纳入了265例疑似UA患者（男性占62.3%，平均年龄：65.0±9.4岁）。F-FDG阳性定义为局灶性或弥漫性摄取模式中的局灶性。MACE包括心血管死亡、急性心肌梗死、心力衰竭、因UA再次住院和中风。采用多变量Cox回归确定MACE的预测因素，并使用一致性指数（C指数）、净重新分类改善（NRI）和综合鉴别改善（IDI）评估F-FDG PET成像的额外预后价值。
在中位随访25个月期间，51例患者（19.2%）发生了MACE。F-FDG阳性（风险比[HR]=3.220，95%置信区间[CI]：1.630-6.360，P<.001），以及F-FDG标准化摄取值（HR=1.330，95%CI：1.131-1.564，P=.0006）和范围（HR=1.045，95%CI：1.028-1.062，P<.0001）是MACE的独立预测因素。添加F-FDG PET成像显著改善了超越临床因素、GRACE评分和CACS的风险分层，C指数提高（.769对.688，P=.045），NRI（.324，P=.020）和IDI（.055，P=.027）。
F-FDG PET心肌缺血记忆成像显著改善了疑似UA患者的预后评估，除了临床危险因素、GRACE评分和CACS外，还提供了有价值的额外风险分层。
