Coronary microcalcification activity detected by PET may predict MI
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Among patients with advanced established CAD, 18F-sodium fluoride PET may predict MI, according to data presented at the virtual American College of Cardiology Scientific Session.
“In patients with established coronary artery disease, 18F-[sodium fluoride] PET provides powerful independent prediction of fatal or nonfatal myocardial infarction,” Jacek Kwiecinski, MD, postdoctoral scientist at Cedars-Sinai, said during the presentation.
Researchers analyzed data from 293 patients (mean age, 65 years; 84% men) with known CAD who underwent 18F-sodium fluoride PET. The primary endpoint was nonfatal or fatal MI. Follow-up was conducted for 42 months.
Of the patients in the study, 69% had increased coronary 18F-sodium fluoride activity, defined as coronary microcalcification activity greater than 0. More patients with coronary microcalcification activity greater than 0 had a fatal or nonfatal MI compared with those without this activity (9.9% vs. 0%; P < .001).
“What we found very interesting was the fact that patients who showed no sodium fluoride uptake had an excellent prognosis,” Kwiecinski said during the presentation.
18F-sodium fluoride coronary microcalcification activity had a higher area under the receiver-operator curve (AUC = 0.76; 95% CI, 0.67-0.84) compared with other clinical predictors including CT coronary calcium scores (AUC = 0.54; 95% CI, 0.38-0.69), modified Duke CAD index (AUC = 0.62; 95% CI, 0.49-0.76) and REACH risk score (AUC = 0.52; 95% CI, 0.38-0.66).
Patients who had coronary microcalcification activity greater than 1.56 had a sevenfold increased risk for MI. This increased risk was independent of sex (P = .67), age (P = .23), segment involvement scores (P = .14), multivessel disease (P = .62), number of stents (P = .84), coronary calcium scores (P = .41), the Duke CAD index and risk models including SMART (P = .12) and REACH (P = .47).
“Now that we have some exciting data regarding new lipid-lowering agents on one hand and medication that targets coronary inflammation, it appears that maybe these are the pathways that would be suitable for those patients,” Kwiecinski said during the presentation. – by Darlene Dobkowski
Reference:
Kwiecinski J, et al. Young Investigator Awards: Clinical Investigations. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).
Disclosure: Kwiecinski reports no relevant financial disclosures.
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