Coronary 18F-Sodium Fluoride Uptake Predicts Outcomes in Patients With Coronary Artery Disease
Coronary 18F-Sodium Fluoride Uptake Predicts Outcomes in Patients With Coronary Artery Disease
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DOI：
10.1016/j.jacc.2020.04.046
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发表时间：
2020-06-23
影响因子：
24
通讯作者：
Dweck, Marc R.
中科院分区：
文献类型：
--
作者：
Kwiecinski, Jacek;Tzolos, Evangelos;Dweck, Marc R.
背景：目前缺乏可靠的方法来预测冠心病患者的心肌梗死。冠脉F-18-氟化钠（F-18-NaF）正电子发射断层扫描（PET）提供了动脉粥样硬化活动的评估。结论本研究评估了F-18-NaF PET是否可预测心肌梗死，并为目前的危险分层方法提供了额外的预后信息。NaF PET计算机断层扫描，并随访42个月（四分位距：31至49个月）的致死性或非致死性心肌梗死。冠状动脉F-18-NaF总摄取量由冠状动脉微钙化活性（CMA）确定。结果在前瞻性观察性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%男性），其中203名（69%）显示冠状动脉F-18-NaF活性增加（CMA >0）。致死性或非致死性心肌梗死仅发生在冠状动脉F-18-NaF活性升高的患者中（203例CMA > 0的患者中有20例vs. CMA为0的90例患者中有0例; p < 0.001）。在受试者操作曲线分析中，F-18-NaF CMA的致死性或非致死性心肌梗死预测值最高，优于冠状动脉钙化评分、改良杜克冠状动脉疾病指数、减少动脉粥样硬化血栓形成以保持健康（REACH）和动脉疾病继发表现（SMART）风险评分（曲线下面积：分别为0.76对0.54、0.62、0.52和0.54;所有均为p < 0.001）。CMA >1.56的患者发生致命性或非致命性心肌梗死的几率增加7倍以上（风险比：7.1; 95%置信区间：2.2至25.1; p = 0.003）独立于年龄、性别、危险因素、节段受累和冠状动脉钙评分、冠状动脉支架存在、冠状动脉狭窄、REACH和SMART评分、杜克冠状动脉疾病指数，结论：在确诊冠心病的患者中，F-18-NaF PET可有效地独立预测致死性或非致死性心肌梗死。（J Am科尔心脏病学2020;75：3061-74）（c）美国心脏病学会基金会2020年。
BACKGROUND Reliable methods for predicting myocardial infarction in patients with established coronary artery disease are lacking. Coronary F-18-sodium fluoride (F-18-NaF) positron emission tomography (PET) provides an assessment of atherosclerosis activity.OBJECTIVES This study assessed whether F-18-NaF PET predicts myocardial infarction and provides additional prognostic information to current methods of risk stratification.METHODS Patients with known coronary artery disease underwent F-18-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-18-NaF uptake was determined by the coronary microcalcification activity (CMA).RESULTS 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-18-NaF activity (CMA >0). Fatal or nonfatal myocardial infarction occurred only in patients with increased coronary F-18-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-18-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.CONCLUSIONS In patients with established coronary artery disease, F-18-NaF PET provides powerful independent prediction of fatal or nonfatal myocardial infarction. (J Am Coll Cardiol 2020;75:3061-74) (c) 2020 by the American College of Cardiology Foundation.