Prediction of outcome by ⁸²Rb PET/CT in patients with ischemia and nonobstructive coronary arteries

Background: The purpose of this study was to assess the prognostic value of cardiac ⁸²Rb positron emission tomography (PET)/computed tomography (CT) imaging in patients with myocardial ischemia of nonobstructive coronary arteries (INOCA).

Methods: We retrospectively evaluated 311 INOCA patients who underwent rest stress ⁸²Rb PET/CT. Cardiac end points were cardiac death, myocardial infarction, or late coronary revascularization. A parametric survival model was also used to identify how the variables influenced time to event.

Results: During a median follow-up of 37 months (range 6-108), 23 (7%) cardiac events occurred. In patients with events total perfusion defect (TPD) was higher and myocardial flow reserve (MFR) lower compared to those without events (both P < .001). At multivariable Cox analysis, increased TPD (i.e., ≥ 5%) and reduced MFR (i.e., < 2) were predictors of events (both P < .001). At Weibull survival analysis, the highest probability of cardiac events and risk acceleration were observed in patients with both increased TPD and reduced MFR. Annualized event rate was higher in patients with reduced MFR compared to those with preserved MFR (P < .001).

Conclusion: In patients with INOCA, the combined evaluation of myocardial perfusion and coronary vascular function by ⁸²Rb PET/CT is able to identify those at higher risk of cardiac events.