¹⁸F-sodium fluoride positron emission tomography following coronary computed tomography angiography in predicting long-term coronary events: a 5-year follow-up study

Purpose: The predictive value of ¹⁸F-sodium fluoride (¹⁸F-NaF) positron emission tomography (PET) in combination with coronary computed tomography (CT) angiography (CCTA) for future coronary events has attracted interest. We evaluated the potential of ¹⁸F-NaF PET/CT following CCTA to predict major coronary events (MACE) during a 5-year follow-up period.

Methods: Forty patients with coronary atherosclerotic lesions detected on CCTA underwent ¹⁸F-NaF PET/CT examination. Each lesion was evaluated for luminal stenosis and high-risk plaque (HRP) with < 30 Hounsfield units and a > 1.1 remodeling index on CCTA. Focal ¹⁸F-NaF uptake in each lesion was quantified using the maximum tissue-to-background ratio (TBR_max), and the maximum TBR_max per patient (M-TBR_max) was determined. We followed MACE (cardiac death, acute coronary syndrome, and/or coronary revascularization > 6 months after ¹⁸F-NaF PET/CT) for 5 years.

Results: In total, 142 coronary lesions were analyzed. Eleven patients experienced any MACE. Patients with MACE showed a higher M-TBR_max than those without (1.40 ± .19 vs. 1.18 ± .18, P = .0011), and the optimal M-TBR_max cutoff to predict MACE was 1.29. Patients with M-TBR_max of ≥ 1.29 had a higher risk of MACE than those with lower values (P = .012, log-rank test), whereas patients with obstructive stenosis and those with HRP did not. Multivariate Cox proportional analysis adjusted for age, sex, coronary risk factors, and CCTA findings showed that M-TBR_max of ≥ 1.29 remained an independent predictor of 5-year MACE (hazard ratio, 5.4; 95% confidence interval, 1.1-25.4; P = .034).

Conclusion: ¹⁸F-NaF PET/CT following CCTA provides useful strategies to predict 5-year MACE.