PMID- 28528146
OWN - NLM
STAT- MEDLINE
DCOM- 20180709
LR  - 20190123
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 10
IP  - 11
DP  - 2017 Nov
TI  - Prognostic Value of Coronary CT Angiography With Selective PET Perfusion Imaging 
      in Coronary Artery Disease.
PG  - 1361-1370
LID - S1936-878X(17)30260-7 [pii]
LID - 10.1016/j.jcmg.2016.10.025 [doi]
AB  - OBJECTIVES: The purpose of this study was to evaluate the prognostic value of 
      sequential hybrid imaging strategy in which positron emission tomography (PET) 
      perfusion imaging is performed selectively in patients with suspected obstructive 
      coronary artery disease (CAD) on coronary computed tomography angiography (CTA). 
      BACKGROUND: Coronary CTA is an accurate diagnostic test for excluding obstructive 
      CAD. However, the positive predictive value is suboptimal. METHODS: We 
      investigated 864 consecutive symptomatic patients with intermediate probability 
      of CAD who adhered to the sequential imaging approach. PET myocardial perfusion 
      imaging using (15)O-labeled water during adenosine stress was performed when 
      suspected obstructive stenosis was present on coronary CTA. The major adverse 
      events (AEs) including all-cause mortality, myocardial infarction (MI), and 
      unstable angina pectoris (UAP) were recorded. RESULTS: During a median follow-up 
      of 3.6 years, 16 deaths, 10 MIs, and 5 UAPs occurred. Obstructive CAD was 
      excluded by coronary CTA in 462 (53%) patients who had significantly lower annual 
      AE rate than did patients with suspected obstructive stenosis on coronary CTA 
      (0.4% vs. 1.5%; p = 0.003). The latter underwent PET study, on which 195 (49%) 
      had normal and 207 had abnormal perfusion. The annual rate of AEs was 5 times 
      higher in those with abnormal perfusion than with normal perfusion (2.5% vs. 
      0.5%; p = 0.004). Patients with normal perfusion had AE rate comparable to 
      patients without obstructive CAD on coronary CTA (p = 0.77). CONCLUSIONS: In 
      patients with suspected CAD obstructive disease can be excluded in 53% of 
      patients by coronary CTA, and these patients have good outcome. About one-half 
      (49%) of the remaining patients have normal perfusion and event rate comparable 
      to patients without obstructive CAD on coronary CTA while patients with ischemia 
      have clearly worse outcome. Sequential approach utilizing anatomical imaging by 
      coronary CTA followed by selective functional perfusion imaging is a feasible 
      strategy to diagnose and risk-stratify patients with suspected CAD.
CI  - Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Maaniitty, Teemu
AU  - Maaniitty T
AD  - Turku PET Centre, University of Turku, Turku, Finland.
FAU - Stenstrom, Iida
AU  - Stenstrom I
AD  - Turku PET Centre, University of Turku, Turku, Finland.
FAU - Bax, Jeroen J
AU  - Bax JJ
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Uusitalo, Valtteri
AU  - Uusitalo V
AD  - Turku PET Centre, University of Turku, Turku, Finland.
FAU - Ukkonen, Heikki
AU  - Ukkonen H
AD  - Heart Center, Turku University Hospital, Turku, Finland.
FAU - Kajander, Sami
AU  - Kajander S
AD  - Turku PET Centre, University of Turku, Turku, Finland.
FAU - Maki, Maija
AU  - Maki M
AD  - Turku PET Centre, University of Turku, Turku, Finland; Department of Clinical 
      Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland.
FAU - Saraste, Antti
AU  - Saraste A
AD  - Turku PET Centre, University of Turku, Turku, Finland; Heart Center, Turku 
      University Hospital, Turku, Finland.
FAU - Knuuti, Juhani
AU  - Knuuti J
AD  - Turku PET Centre, University of Turku, Turku, Finland; Department of Clinical 
      Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland. 
      Electronic address: juhani.knuuti@utu.fi.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170517
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Vasodilator Agents)
RN  - K72T3FS567 (Adenosine)
SB  - IM
CIN - JACC Cardiovasc Imaging. 2017 Nov;10(11):1371-1373. PMID: 28528157
MH  - Adenosine/administration & dosage
MH  - Aged
MH  - Angina, Unstable/etiology
MH  - *Computed Tomography Angiography
MH  - Coronary Angiography/*methods
MH  - Coronary Artery Disease/complications/*diagnostic 
      imaging/mortality/physiopathology
MH  - *Coronary Circulation
MH  - Coronary Stenosis/complications/*diagnostic imaging/mortality/physiopathology
MH  - Coronary Vessels/*diagnostic imaging/physiopathology
MH  - Disease Progression
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Multimodal Imaging
MH  - Myocardial Infarction/etiology
MH  - Myocardial Perfusion Imaging/*methods
MH  - *Positron Emission Tomography Computed Tomography
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Vasodilator Agents/administration & dosage
OTO - NOTNLM
OT  - computed tomography angiography
OT  - coronary artery disease
OT  - hybrid imaging
OT  - myocardial perfusion
OT  - positron emission tomography
EDAT- 2017/05/22 06:00
MHDA- 2018/07/10 06:00
CRDT- 2017/05/22 06:00
PHST- 2016/07/05 00:00 [received]
PHST- 2016/10/21 00:00 [revised]
PHST- 2016/10/27 00:00 [accepted]
PHST- 2017/05/22 06:00 [pubmed]
PHST- 2018/07/10 06:00 [medline]
PHST- 2017/05/22 06:00 [entrez]
AID - S1936-878X(17)30260-7 [pii]
AID - 10.1016/j.jcmg.2016.10.025 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2017 Nov;10(11):1361-1370. doi: 
      10.1016/j.jcmg.2016.10.025. Epub 2017 May 17.