Coronary sodium [18F]fluoride activity predicts outcomes post-CABG: a comparative evaluation with conventional metrics

Mingxin Gao; Wanwan Wen; Haiyang Li; Yaqi Zheng; Mingkai Yun; Jingjing Meng; Shipan Wang; Bolin Wang; Biao Hu; Tiantian Mou; Yang Yu; Xiaoli Zhang; Xiang Li

doi:10.1007/s00259-024-06736-4

Coronary sodium [¹⁸F]fluoride activity predicts outcomes post-CABG: a comparative evaluation with conventional metrics

Eur J Nucl Med Mol Imaging. 2024 May 11. doi: 10.1007/s00259-024-06736-4. Online ahead of print.

Authors

Mingxin Gao^#^{1

2}, Wanwan Wen^#¹, Haiyang Li^#², Yaqi Zheng², Mingkai Yun¹, Jingjing Meng¹, Shipan Wang², Bolin Wang², Biao Hu¹, Tiantian Mou¹, Yang Yu³, Xiaoli Zhang⁴, Xiang Li⁵

Affiliations

¹ Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China.
² Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China.
³ Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China. 13911524101@163.com.
⁴ Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China. xlzhang68@126.com.
⁵ Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.

^# Contributed equally.

PMID: 38730084
DOI: 10.1007/s00259-024-06736-4

Abstract

Purpose: The value of preoperative multidisciplinary approach remains inadequately delineated in forecasting postoperative outcomes of patients undergoing coronary artery bypass grafting (CABG). Herein, we aimed to ascertain the efficacy of multi-modality cardiac imaging in predicting post-CABG cardiovascular outcomes.

Methods: Patients with triple coronary artery disease underwent cardiac sodium [¹⁸F]fluoride ([¹⁸F]NaF) positron emission tomography/computed tomography (PET/CT), coronary angiography, and CT-based coronary artery calcium scoring before CABG. The maximum coronary [¹⁸F]NaF activity (target-to-blood ratio [TBR]_max) and the global coronary [¹⁸F]NaF activity (TBR_global) was determined. The primary endpoint was perioperative myocardial infarction (PMI) within 7-day post-CABG. Secondary endpoint included major adverse cardiac and cerebrovascular events (MACCEs) and recurrent angina.

Results: This prospective observational study examined 101 patients for a median of 40 months (interquartile range: 19-47 months). Both TBR_max (odds ratio [OR] = 1.445; p = 0.011) and TBR_global (OR = 1.797; P = 0.018) were significant predictors of PMI. TBR_max>3.0 (area under the curve [AUC], 0.65; sensitivity, 75.0%; specificity, 56.8%; p = 0.036) increased PMI risk by 3.661-fold, independent of external confounders. Kaplan-Meier test revealed a decrease in MACCE survival rate concomitant with an escalating TBR_max. TBR_max>3.6 (AUC, 0.70; sensitivity, 76.9%; specificity, 73.9%; p = 0.017) increased MACCEs risk by 5.520-fold. Both TBR_max (hazard ratio [HR], 1.298; p = 0.004) and TBR_global (HR = 1.335; p = 0.011) were significantly correlated with recurrent angina. No significant associations were found between CAC and SYNTAX scores and between PMI occurrence and long-term MACCEs.

Conclusion: Quantification of coronary microcalcification activity via [¹⁸F]NaF PET displayed a strong ability to predict early and long-term post-CABG cardiovascular outcomes, thereby outperforming conventional metrics of coronary macrocalcification burden and stenosis severity.

Trial registration: The trial was registered with the Chinese Clinical Trial Committee (number: ChiCTR1900022527; URL: www.chictr.org.cn/showproj.html?proj=37933 ).

Keywords: Coronary artery bypass grafting; Coronary artery disease; Positron emission tomography/computed tomography; Prognosis; Sodium [18F]fluoride.