Cardiology · 5 h ago
Sequential CCTA and PET stratify long-term risk in suspected coronary disease
A multicentre European cohort study followed 3,918 symptomatic patients after coronary CT angiography (CCTA), with selective quantitative PET for suspected obstructive disease. CCTA findings were associated with long-term risk, while PET-detected ischaemia added prognostic information mainly for events that included unstable-angina hospitalization.
- CCTA disease burden tracked with long-term risk.
- PET ischaemia added risk information for the composite endpoint.
- PET’s incremental association was not significant for hard outcomes alone.
In this multicentre European cohort, 3,918 patients with first symptoms suggestive of obstructive coronary artery disease underwent CCTA; those with suspected stenosis of at least 50% were selectively referred for quantitative [15O]H2O PET. The primary endpoint combined all-cause mortality, non-fatal myocardial infarction and hospitalization for unstable angina. Median follow-up was 5.1 years, and 278 patients (7.1%) experienced the endpoint.
Risk increased across imaging categories. Compared with normal CCTA, non-obstructive disease was associated with an adjusted hazard ratio (aHR) of 1.89 (95% CI 1.23–2.91), and obstructive disease without PET ischaemia with an aHR of 3.20 (95% CI 1.95–5.25). Among patients with obstructive CCTA findings, PET ischaemia further increased risk for the composite endpoint (aHR 1.55, 95% CI 1.05–2.30), but not when unstable-angina hospitalization was excluded (aHR 1.37, 95% CI 0.90–2.07).
PET ischaemia primarily predicted events in the first year, whereas obstructive CCTA findings remained associated with long-term hard outcomes. The observational design establishes prognostic associations, not that imaging-guided management improves outcomes. PET’s incremental association also depended on including unstable-angina hospitalization in the composite endpoint.
In practice
For symptomatic patients evaluated for suspected obstructive coronary disease, these cohort findings indicate that CCTA disease burden is associated with long-term outcomes, while PET-derived ischaemia may add prognostic information, particularly for events including unstable-angina hospitalization and during the first year. The results support the prognostic role of the sequential imaging strategy but do not show that imaging-guided treatment changes improve outcomes. Because the study is observational and PET’s additional association was not significant for the composite excluding unstable angina, it does not establish a treatment or testing mandate.
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European Heart Journal - Cardiovascular Imaging: Long-term Prognostic Value of Sequential Coronary CT Angiography and Quantitative PET in Suspected Chronic Coronary Syndromes: A Multicentre study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.