Noninvasive In Vivo Coronary Artery Thrombus Imaging.

Area of Science:

• Cardiovascular Imaging
• Nuclear Medicine
• Radiopharmaceutical Development

Background:

• Myocardial infarction (MI) diagnosis and management are complex, with intracoronary thrombosis significantly impacting classification and treatment.
• Accurate identification of in vivo thrombus is crucial for effective MI patient care.

Purpose of the Study:

• To evaluate the efficacy of a novel glycoprotein IIb/IIIa receptor antagonist-based radiotracer, 18F-GP1, for noninvasive in vivo detection of coronary thrombus using PET/CT imaging.
• To assess the diagnostic performance of 18F-GP1 PET/CT angiography in patients with and without acute myocardial infarction.

Main Methods:

• A single-center observational case-control study involving patients with or without acute myocardial infarction.
• Coronary 18F-GP1 PET/CT angiography was performed, with coronary artery 18F-GP1 uptake assessed visually and quantified.
• Analysis included multivariable regression to identify factors associated with tracer uptake.

Main Results:

• 18F-GP1 PET/CT detected coronary thrombus in 80% of culprit lesions in patients with acute MI.
• Culprit vessel status was the only independent predictor of higher 18F-GP1 uptake.
• Extracoronary findings included intramyocardial uptake (35%) and cardiac thrombus (left ventricular 8%, left atrial 2%).

Conclusions:

• Coronary 18F-GP1 PET/CT angiography is the first noninvasive technique to selectively identify in vivo coronary thrombosis in acute MI patients.
• This novel approach can delineate thrombosis location and role, potentially guiding MI diagnosis and treatment.
• The iThrombus study (NCT03943966) highlights the potential of 18F-GP1 for improving acute myocardial infarction management.