Appropriate coronary revascularization can be accomplished if myocardial perfusion is quantified by positron emission tomography prior to treatment decision

J Nucl Cardiol. 2021 Aug;28(4):1664-1672. doi: 10.1007/s12350-019-01938-y. Epub 2019 Nov 8.

Abstract

Background: Many patients undergo percutaneous coronary intervention (PCI) without the use of non-invasive stress testing prior to treatment. The aim of this study was to determine the potential added value of guiding revascularization by quantitative assessment of myocardial perfusion prior to intervention.

Methods and results: Thirty-three patients (10 females) with suspected or established CAD who had been referred for a clinical coronary angiography (CA) with possibility for PCI were included. Adenosine stress and rest 13N-NH3 PET, cardiac magnetic resonance (CMR), and cardiopulmonary exercise test were performed 4 ± 3 weeks before and 5 ± 1 months after CA. The angiographer was blinded to the PET and CMR results. Myocardial flow reserve (MFR) < 2.0 by PET was considered abnormal. A PCI was performed in 19/33 patients. In 41% (11/27) of the revascularized vessel territories, a normal regional MFR was found prior to the PCI and no improvement in MFR was found at follow-up (P = 0.9). However, vessel territories with regional MFR < 2.0 at baseline improved significantly after PCI (P = 0.003). Of the 14 patients not undergoing PCI, four had MFR < 2.0 in one or more coronary territories.

Conclusion: Assessment of quantitative myocardial perfusion prior to revascularization could lead to more appropriate use of CA when managing patients with stable CAD.

Keywords: Coronary artery disease; coronary angiography; revascularization; stress imaging.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Coronary Angiography
  • Coronary Artery Bypass*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / surgery*
  • Exercise Test
  • Female
  • Fractional Flow Reserve, Myocardial / physiology
  • Humans
  • Male
  • Middle Aged
  • Myocardial Perfusion Imaging*
  • Patient Selection
  • Percutaneous Coronary Intervention*
  • Positron-Emission Tomography*
  • Prospective Studies
  • Treatment Outcome