The following is a summary of “Coronary Atherosclerotic Plaque Activity and Risk of MI,” published in the May 2024 issue of Cardiology by Wang et al.
Researchers conducted a prospective study verifying any correlation between vessel-level coronary plaque activity and myocardial infarction (MI) using 18F-sodium fluoride PET scans.
They conducted the Prediction of Recurrent Events with 18F-Fluoride to Identify Ruptured and high-risk coronary artery plaques in patients with myocardial infarction (PRE18FFIR) study globally across 9 different sites and enrolled patients over 50 with recent type 1 MI and multivessel coronary artery disease (CAD) between September 2015 and February 2020. Patients underwent various imaging tests (attenuation-correction computed tomography (CT), dual cardiac and respiratory-gated PET of the thorax, and electrocardiogram-fated CT coronary arteriography (CTCA) after receiving 250 MBq 18F-sodium fluoride. Image analysis wasn’t used for clinical decisions. The coronary plaque activity was measured in significant vessels using 18F-sodium fluoride uptake, regardless of stent presence, and focusing on subsequent MIs in specific vessel areas. Patient outcomes included cardiac death or MI, as well as isolated MIs, tracked for at least 2 years.
The results showed increased 18F-sodium fluoride uptake in 679 of 2,094 coronary arteries and 414 of 691 patients. With CTCA, 2,094 analyzable coronary arteries were identified, of which 832 (40%) were treated with percutaneous coronary intervention at index MI; the rest were not. During four years, MI occurred in 24 (4%) vessels with increased coronary atherosclerotic plaque activity and in 25 (2%) without (HR 2.08, 95% CI: [1.16-3.72], P=0.013). This association was notable in untreated vessels (3.86, [1.63-9.10]) but not in patients with revascularization (1.02, [0.47-2.25]) (P for interaction= 0.024). Increased plaque activity in multiple arteries raised the risk of cardiac death or MI (2.43, [1.37-4.30], P=0.002), first MI (2.19, [1.18-4.06], P=0.013), and total MIs (2.50, [1.42-4.39], P=0.002). This increased plaque activity was predominantly seen in coronary arteries without residual obstructive lesions.
Investigators concluded that coronary plaque activity in patients with recent MI and multivessel CAD predicts which arteries and patients were at risk for future MI.
Source: acc.org/Latest-in-Cardiology/Journal-Scans/2024/05/30/16/31/coronary-atherosclerotic-plaque