J Korean Med Sci.  2023 Nov;38(46):e399. 10.3346/jkms.2023.38.e399.

Impact of Positron Emission Tomography Viability Imaging: Guided Revascularizations on Clinical Outcomes in Patients With Myocardial Scar on Single-Photon Emission Computed Tomography Scans

• Park JS
• Lee JH
• Hong CM
• Park BE
• Park YJ
• Kim HN
• Kim N
• Jang SY
• Bae MH
• Yang DH
• Park HS
• Cho Y

• KMID: 2548559
• DOI: http://doi.org/10.3346/jkms.2023.38.e399

Abstract

Background
Positron emission tomography (PET) viability scan is used to determine whether patients with a myocardial scar on single-photon emission computed tomography (SPECT) may need revascularization. However, the clinical utility of revascularization decision-making guided by PET viability imaging has not been proven yet. The purpose of this study was to investigate the impact of PET to determine revascularization on clinical outcomes.
Methods
Between September 2012 and May 2021, 53 patients (37 males; mean age = 64 ± 11 years) with a myocardial scar on MIBI SPECT who underwent PET viability test were analyzed in this study. The primary outcome was a temporal change in echocardiographic findings. The secondary outcome was all-cause mortality.
Results
Viable myocardium was presented by PET imaging in 29 (54.7%) patients. Revascularization was performed in 26 (49.1%) patients, including 18 (34.0%) with percutaneous coronary intervention (PCI) and 8 (15.1%) with coronary artery bypass grafting. There were significant improvements in echocardiographic findings in the revascularization group and the viable myocardium group. All-cause mortality was significantly lower in the revascularization group than in the medical therapy-alone group (19.2% vs. 44.4%, log-rank P = 0.002) irrespective of viable (21.4% vs. 46.7%, log-rank P = 0.025) or non-viable myocardium (16.7% vs. 41.7%, log-rank P = 0.046). All-cause mortality was significantly lower in the PCI group than in the medical therapy-alone group (11.1% vs. 44.4%, log-rank P < 0.001).
Conclusion
Revascularization improved left ventricular systolic function and survival of patients with a myocardial scar on SPECT scans, irrespective of myocardial viability on PET scans.

Keyword

Myocardial Scar; Positron Emission Tomography; Single-Photon Emission Computed Tomography; Revascularization; Percutaneous Coronary Intervention; Prognosis

Figure

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  Fig. 1 Study flow diagram.KNUH = Kyungpook National University Hospital, CMP = cardiomyopathy, SPECT = single-photon emission computed tomography, PET = positron emission tomography.

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  Fig. 2 Kaplan–Meier survival curve for all-cause mortality between viable and non-viable groups.

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  Fig. 3 Kaplan–Meier survival curve for all-cause mortality (A) between the revascularization and medical therapy-alone groups, particularly in viable (B) and non-viable myocardium groups (C) on positron emission tomography scans. Kaplan–Meier survival curve for all-cause mortality (D) between the percutaneous coronary intervention and medical therapy-alone groups, particularly in viable (E) and non-viable myocardium groups (F) on positron emission tomography scans.PCI = percutaneous coronary intervention.

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