Stress Myocardial Perfusion PET Provides Incremental Risk Prediction in Patients with and Patients without Diabetes.

Abstract

PURPOSE:

To evaluate the prognostic value of myocardial perfusion PET in patients with and patients without diabetes mellitus.

MATERIALS AND METHODS:

The authors performed a retrospective analysis of prospectively acquired data from a multicenter registry cohort of 7061 patients, including 1966 with diabetes mellitus, who underwent clinically indicated rest-stress rubidium 82 (82Rb) myocardial perfusion PET. The mean patient age (±standard deviation) was 63.3 years ± 13. Of the 7061 patients, 3348 were women (47.4%), 2296 (32.5%) had known coronary artery disease, and 1895 (26.8%) had previously undergone revascularization. The primary end point was cardiac death (n = 169) assessed at a mean of 2.5 years ± 1.5. The authors used Cox proportional hazards models and risk reclassification measures stratified according to diabetes status.

RESULTS:

In multivariable models adjusting for established clinical predictors, increasing magnitude of stress myocardial perfusion abnormality was associated with greater risk of cardiac death in patients with diabetes (hazard ratio [HR]: 7.2; 95% confidence interval [CI]: 3.1, 16.8) for severely abnormal myocardium compared with normal myocardium. The addition of stress myocardial perfusion imaging results significantly improved the fit of a clinical model for predicting cardiac death in patients with and patients without diabetes. Myocardial perfusion PET improved risk reclassification for cardiac death in patients with diabetes (category-based net reclassification index: 0.39; 95% CI: 0.15, 0.60, P < .001). Among diabetic patients, an abnormal myocardial perfusion PET scan was associated with increased risk of cardiac death (HR: 4.4; 95% CI: 2.0, 9.7) in all important clinical subgroups based on age, sex, obesity, or prior revascularization.

CONCLUSION:

In a large cohort of patients referred for clinical 82Rb stress PET, myocardial perfusion imaging results provided incremental risk prediction of cardiac death in patients with and patients without diabetes mellitus.© RSNA, 2019Supplemental material is available for this article.

• Authors: Hicham Skali, Marcelo F Di Carli, Ron Blankstein, Benjamin J Chow, Rob S Beanlands, Daniel S Berman, Guido Germano, James K Min, Michael Merhige, Brent Williams, Emir Veledar, Leslee J Shaw, Sharmila Dorbala
• Journal: Radiology. Cardiothoracic imaging (Radiol Cardiothorac Imaging) Vol. 1 Issue 2 Pg. e180018 (Jun 2019) ISSN: 2638-6135 [Electronic] United States
• PMID: 33778500 (Publication Type: Journal Article)
• Copyright: 2019 by the Radiological Society of North America, Inc.