Edinburgh Imaging

22 Jun 20. Featured Paper

Coronary 18F-sodium fluoride uptake predicts outcomes in patients with coronary artery disease.

Link to paper on JACC Journals



Jacek Kwiecinski, Evangelos TzolosPhilip D. Adamson, Sebastien Cadet, Alastair J. Moss, Nikhil JoshiMichelle C. WilliamsEdwin J.R. van Beek, Damini Dey, Daniel S. Berman, David E. Newby, Piotr J. Slomka & Marc R. Dweck



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 & provides additional prognostic information to current methods of risk stratification.

Methods: Patients with known coronary artery disease underwent 18F-NaF PET computed tomography & 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 & Reduction of Atherothrombosis for Continued Health (REACH) & Secondary Manifestations of Arterial Disease (SMART) risk scores (area under the curve: 0.76 vs. 0.54, 0.62, 0.52, & 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 & coronary calcium scores, presence of coronary stents, coronary stenosis, REACH & SMART scores, the Duke coronary artery disease index, & recent myocardial infarction.

Conclusions: In patients with established coronary artery disease18F-NaF PET provides powerful independent prediction of fatal or nonfatal myocardial infarction.





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Featured paper: Coronary 18F-sodium fluoride uptake predicts outcomes in patients with coronary artery disease. @MarcDweck @imagingmedsci @JACCJournals @EdinUniCVS #CoronaryArteryDisease #MyocardialInfarction #PET