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Stress Myocardial Perfusion PET Provides Incremental Risk Prediction in Patients with and Patients without Diabetes
Hicham Skali1, Marcelo F Di Carli1, Ron Blankstein1
1Cardiovascular Division and Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (H.S., M.F.D., R.B., S.D.); University of Ottawa Heart Institute, Ottawa, Canada (B.J.C., R.S.B.); Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B., G.G.); New York-Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.K.M.); Niagara Falls Memorial Medical Center, Niagara Falls, NY (M.M.); Geisinger Health System, Danville, Pa (B.W.); Baptist Health South Florida, Miami, Fla (E.V.); and Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Ga (L.J.S.).
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.
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