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

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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 (TBRglobal) 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 TBRmax (odds ratio [OR] = 1.445; p = 0.011) and TBRglobal (OR = 1.797; P = 0.018) were significant predictors of PMI. TBRmax>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 TBRmax. TBRmax>3.6 (AUC, 0.70; sensitivity, 76.9%; specificity, 73.9%; p = 0.017) increased MACCEs risk by 5.520-fold. Both TBRmax (hazard ratio [HR], 1.298; p = 0.004) and TBRglobal (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).

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Prof. Thomas Beyer and Dr. Ivo Raush from the QIMP Team, Medical University Vienna, for their advice on the imaging reconstruction protocol.

Funding

This research was funded by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (grant number: ZYLX202110), the National Natural Science Foundation of China (grant number: 82171994), the Beijing Municipal Natural Science Foundation (grant number: 7232040), the Beijing Hospitals Authority Youth Program (grant number: QML20230603), the Beijing Hospitals Authority’s Ascent Plan (grant number: DFL20220605), and the Science and Technology Development Fund of Beijing Anzhen Hospital (NO. AZ2022).

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Author notes

  1. Mingxin Gao, Wanwan Wen and Haiyang Li contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China

    Mingxin Gao, Wanwan Wen, Mingkai Yun, Jingjing Meng, Biao Hu, Tiantian Mou & Xiaoli Zhang

  2. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China

    Mingxin Gao, Haiyang Li, Yaqi Zheng, Shipan Wang, Bolin Wang & Yang Yu

  3. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria

    Xiang Li

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  1. Mingxin Gao
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Contributions

Drs GM, WW, LH and Profs ZX, YY contributed equally to the study. Prof ZX had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: GM, WW, LH, ZX, YY. Acquisition, analysis, or interpretation of data: GM, WW, LH, ZY, MJ, WS, WB. Drafting of the manuscript: GM, WW, LX. Critical revision of the manuscript for important intellectual content: ZX, LX, YM, MT. Statistical analysis: GM, WW, LH, ZY. Obtained funding: ZX, YY, LH. Supervision: ZX, YY, LX.

Corresponding authors

Correspondence to Yang Yu or Xiaoli Zhang.

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This study was conducted in accordance with the Declaration of Helsinki and approved by the Beijing Anzhen Hospital Medical Ethics Committee (reference number: 2018055X).

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 2, 3 and 7.

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Gao, M., Wen, W., Li, H. et al. Coronary sodium [18F]fluoride activity predicts outcomes post-CABG: a comparative evaluation with conventional metrics. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06736-4

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