Abstract
Background: The predictive value of 18 F-sodium fluoride ( 18 F-NaF) positron emission tomography (PET) for coronary events has attracted interest. We evaluated the usefulness of 18 F-NaF PET following coronary computed tomography (CT) angiography (CCTA) in predicting major coronary events (CEs) during a 5-year period. Methods: This study included 40 patients with ≥1 coronary atherosclerotic lesion detected on CCTA who underwent 18 F-NaF PET/CT. Each lesion was evaluated with luminal stenosis and the presence of high-risk plaque (HRP) defined as plaque with low density (<30 Hounsfield units) and high remodeling index (>1.1). Focal 18 F-NaF uptake in each lesion was quantified using maximum tissue-to-background ratio (TBR max ), and maximum TBR max per patient (M-TBR max ) was determined. We followed CEs (cardiac death, acute coronary syndrome, and/or coronary revascularization >6 months after 18 F-NaF PET/CT scan) for 5 years. Results: A total of 142 coronary lesions were analyzed. Eleven patients (28%) experienced any CE: 1 had sudden cardiac death, 1 had myocardial infarction, 3 had unstable angina requiring hospitalization, and 6 underwent late coronary revascularization. The frequencies of ≥70% stenosis (64% vs. 55%, p = 0.63) and HRP (83% vs. 62%, p = 0.23) on CCTA were not different between patients with CE and those without. Patients with CE showed a higher M-TBR max (1.40 ± 0.19 vs. 1.18 ± 0.18, p = 0.0011), and its optimal cutoff to predict future CE was 1.29 (area under curve 0.79). Patients with ≥1.29 M-TBR max had a higher risk of CE than those without (Fig 1), whereas patients with ≥70% stenosis and those with HRP did not (Fig 2). Multivariate Cox proportional analysis adjusted for age, sex, the presence of coronary risk factors, and CCTA findings showed that ≥1.29 M-TBR max remained as an independent predictor of the 5-year CE (hazard ratio, 5.4; 95% CI, 1.1-25.4; p = 0.034). Conclusions: 18 F-NaF PET following CCTA has a promising potential to predict long-term CEs.
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