Long term prognostic value of coronary atherosclerotic burden, myocardial perfusion and coronary flow capacity by 82Rb PET in patients with and without known coronary artery disease

Purpose We assessed the long-term prognostic value of the combined evaluation coronary atherosclerotic burden, myocardial perfusion coronary and flow capacity (CFC) derived from 82Rb positron emission tomography (PET)/computed tomography (CT), in a large cohort of patients with suspected or known coronary artery disease (CAD). Methods We studied 5285 patients with suspected or known CAD who underwent to stress/rest cardiac 82Rb PET/CT imaging. Coronary artery calcium (CAC) scores were calculated and categorized as < 400 and ≥ 400. Stress TPD was considered abnormal when ≥ 5%. Baseline and hyperemic MBF were calculated. MFR was obtained and considered reduced when <2. According to previously defined thresholds CFC was calculated. The outcome endpoints were cardiac death, myocardial infarction, and revascularization procedures whichever occurred first. Results During a mean time of 43±26 months, 683 events occurred (13% cumulative event rate, with an AER of 2.9% person-years). The events were 127 (19%) cardiac death, 250 (37%) myocardial infarction and 306 (45%) coronary revascularizations. In patients with previous history of CAD angina, stress TPD, MFR and CFC resulted predictors of events (all P<0.001). Differently, in patients without CAD diabetes, CAC score ≥ 400, stress TPD ≥ 5%, MFR < 2 and impaired CFC resulted as independent predictors. Weibull analysis showed that patients with known CAD, stress TPD ≥ 5%, MFR < 2 and impaired CFC had the highest probability of events. Conclusion The combined evaluation of myocardial perfusion and CFC can predict outcome in both patients with and without known CAD.