Abstract 11013: Prognostic Value of 18F-Sodium Fluoride Positron Emission Tomography for the Prediction of Coronary Events: Comparison and Combination With Computed Tomography

BackgroundPrevious studies indicate F-sodium fluoride (F-NaF) positron emission tomography (PET) detects metabolically active coronary plaques. There has been no evidence demonstrating the prognostic value of F-NaF PET for the prediction of coronary events.MethodsThirty-two patients with ≥1 coronary plaques detected on coronary computed tomography angiography (CCTA) underwent F-NaF PET/CT. CCTA-based high-risk plaque (HRP) was defined by the presence of low density (1.1). Focal F-NaF uptake of each plaque was quantified using maximum tissue-to-background ratio (TBRmax), and maximum TBRmax per patient (M-TBRmax) was determined. We followed combined coronary events (acute coronary syndrome and/or coronary revascularization >3 months after F-NaF PET/CT scan) for 2 years.ResultsA total of 112 coronary plaques were analyzed. Eleven patients (34%) experienced any coronary event1 had myocardial infarction, 3 had unstable angina requiring hospitalization, and 7 underwent late coronary revascularization. Between patients with coronary event and those without, the frequencies of ≥70% stenosis (82 vs. 57%, p = 0.16) and HRP (73 vs. 62%, p = 0.54) on CCTA were not different. On the one hand, patients with coronary event showed a higher M-TBRmax (1.39 ± 0.18 vs. 1.19 ± 0.17, p = 0.0034), and its optimal cutoff to predict future coronary event was 1.28 (area under curve 0.79). Patients with ≥1.28 M-TBRmax had a higher risk of earlier coronary events 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 statin use showed that ≥1.28 M-TBRmax remained as an independent predictor of the 2-year coronary events (hazard ratio, 5.0; 95% CI, 1.1-30.8; p = 0.037).ConclusionsF-NaF PET following CCTA has a promising potential to predict future coronary events noninvasively.