Author + information
- Received February 9, 2020
- Revision received March 9, 2020
- Accepted April 21, 2020
- Published online June 15, 2020.
- Jacek Kwiecinski, MD, PhDa,b,∗,
- Evangelos Tzolos, MDa,c,∗,
- Philip D. Adamson, MD, PhDc,
- Sebastien Cadet, MSa,
- Alastair J. Moss, MDc,
- Nikhil Joshi, PhDc,
- Michelle C. Williams, MD, PhDc,
- Edwin J.R. van Beek, MD, PhDc,d,
- Damini Dey, PhDa,
- Daniel S. Berman, MDa,
- David E. Newby, MD, PhDc,
- Piotr J. Slomka, PhDa,∗,† (, )@Piotr_JSlomka and
- Marc R. Dweck, MD, PhDc,†
- aDepartment of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
- bDepartment of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
- cBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- dEdinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- ↵∗Address for correspondence:
Dr. Piotr J. Slomka, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite A047N, Los Angeles, California 90048.
Background Reliable methods for predicting myocardial infarction in patients with established coronary artery disease are lacking. Coronary 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) provides an assessment of atherosclerosis activity.
Objectives This study assessed whether 18F-NaF PET predicts myocardial infarction and provides additional prognostic information to current methods of risk stratification.
Methods Patients with known coronary artery disease underwent 18F-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 18F-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 18F-NaF activity (CMA >0). Fatal or nonfatal myocardial infarction occurred only in patients with increased coronary 18F-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 18F-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, 18F-NaF PET provides powerful independent prediction of fatal or nonfatal myocardial infarction.
- coronary artery disease
- coronary computed tomography
- coronary event risk prediction
- 18F-NaF PET
- myocardial infarction
↵∗ Drs. Kwiecinski and Tzolos are co-first authors.
↵† Drs. Slomka and Dweck are co-senior authors.
This research was supported in part by grants (R01HL135557) from the National Heart, Lung, and Blood Institute/National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Tzolos was supported by a grant from the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation. Drs. Berman, Dey, and Slomka, and Mr. Cadet have received software royalties from Cedars-Sinai Medical Center. Dr. Williams is supported by the British Heart Foundation (FS/11/014, CH/09/002). Dr. van Beek is supported by the Scottish Imaging Network, a Platform of Scientific Excellence (SINAPSE); has received research support from Siemens Healthineers and GE Healthcare; has served on the Advisory Boards for Aidence and Imbio; has been a consultant for Mantholatum; and is the owner of QCTIS, Ltd. Dr. Newby is supported by the British Heart Foundation (CH/09/002, RE/18/5/34216, RG/16/10/32375); and is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr. Slomka has received a grant from the National Institutes of Health and software royalties from Cedars-Sinai. Dr. Dweck is supported by the British Heart Foundation (FS/14/78/31020); and is the recipient of a Sir Jules Thorn Award for Biomedical Research Award (2015). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received February 9, 2020.
- Revision received March 9, 2020.
- Accepted April 21, 2020.
- 2020 American College of Cardiology Foundation
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