A highly predictive cardiac positron emission tomography (PET) risk score for 90-day and one-year major adverse cardiac events and revascularization

With the increase in cardiac PET/CT availability and utilization, the development of a PET/CT-based major adverse cardiovascular events, including death, myocardial infarction (MI), and revascularization (MACE-Revasc) risk assessment score is needed. Here we develop a highly predictive PET/CT-based risk score for 90-day and one-year MACE-Revasc. 11,552 patients had a PET/CT from 2015 to 2017 and were studied for the training and development set. PET/CT from 2018 was used to validate the derived scores (n = 5049). Patients were on average 65 years old, half were male, and a quarter had a prior MI or revascularization. Baseline characteristics and PET/CT results were used to derive the MACE-Revasc risk models, resulting in models with 5 and 8 weighted factors. The PET/CT 90-day MACE-Revasc risk score trended toward outperforming ischemic burden alone [P = .07 with an area under the curve (AUC) 0.85 vs 0.83]. The PET/CT one-year MACE-Revasc score was better than the use of ischemic burden alone (P < .0001, AUC 0.80 vs 0.76). Both PET/CT MACE-Revasc risk scores outperformed risk prediction by cardiologists. The derived PET/CT 90-day and one-year MACE-Revasc risk scores were highly predictive and outperformed ischemic burden and cardiologist assessment. These scores are easy to calculate, lending to straightforward clinical implementation and should be further tested for clinical usefulness. 在40-70%有缺血症状的患者中, 有创冠状动脉造影检查未发现梗阻性冠状动脉疾病 (INOCA) 。当这一病变组接受冠状动脉功能学检查, 大约三分之二的人有明显的冠状动脉微血管功能障碍 (CMD), 这与不良预后独立相关。CMD有四种不同的表型或亚组, 每种表型都有独特的病理生理机制和对应的不同治疗策略。CMD临床表型包括微血管性心绞痛、血管痉挛性心绞痛、混合型 (微血管和血管痉挛) 和非心脏症状 (重新分类为非INOCA) 。冠状动脉血管运动障碍国际研究组 (COVADIS) 提出了标准化的诊断标准。临床医生和指南对这些疾病的认识也在不断提高。 CorMicA研究提倡 "功能性血管造影 "的概念以指导分层医学治疗。对CMD的检测可以采用侵入性或非侵入性的方式进行。治疗方法大致分为两类: 控制心血管风险和缓解心绞痛症状。患者治疗管理应个体化, 并定期重新评估疗效。基于表型的管理对患者和临床医生来说都是值得努力的, 这与 "精准医学 "以改善预后、症状改善和提高生活质量的概念相一致。在此, 我们对于INOCA患者提出了一种基于表型管理的现代方法。