Abstract
BackgroundMany 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 ResultsThirty-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. ConclusionAssessment of quantitative myocardial perfusion prior to revascularization could lead to more appropriate use of CA when managing patients with stable CAD.
Highlights
Stable coronary artery disease (CAD), characterized by the presence of atherosclerotic plaques in one or more of the main coronary arteries, is one of the leading causes of heart failure and cardiovascular death in the western world.[1]
Assessment of quantitative myocardial perfusion prior to revascularization could lead to more appropriate use of coronary angiography (CA) when managing patients with stable CAD. (J Nucl Cardiol 2021;28:1664–72.)
Following coronary artery bypass surgery (CABG), one patient had an infarct by late gadolinium-enhanced (LGE) CMR not seen at baseline
Summary
Stable coronary artery disease (CAD), characterized by the presence of atherosclerotic plaques in one or more of the main coronary arteries, is one of the leading causes of heart failure and cardiovascular death in the western world.[1] If the plaques become stenotic it may cause stress-induced myocardial ischemia within the myocardium supplied by the affected artery. Revascularization, either by the way of percutaneous coronary intervention (PCI) or a coronary artery bypass surgery (CABG), is aimed to treat coronary stenosis causing stress-induced ischemia 1 and thereby relieve symptoms as well as improve prognosis in patients with stable CAD.[2] successful elective revascularization is expected to restore the myocardial perfusion (MP) and the regional left ventricular function as well as improve the patient’s exercise capacity. The aim of this study was to determine the potential added value of guiding revascularization by quantitative assessment of myocardial perfusion prior to intervention
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