Abstract 13207: Long term Follow-up of Outcomes with F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging- Assisted Management of Patients with Severe Left Ventricular dysfunction Secondary to Coronary Disease
PARR-2 randomly allocated patients with ischemic cardiomyopathy being considered for revascularization (revasc) to PET-guided vs. standard care. After one year of follow up, the PET group tended to have improved outcome with a significant benefit shown in patients where the PET recommendation was adhered to. A post-hoc analysis showed that the extent of hibernating myocardium predicted outcome benefit from revasc. Herein we present results after 5 years of follow up.
Methods: Included patients had an LV ejection fraction of </=35% due to CAD and were being considered for revasc. Patients were randomized to care guided by a PET scan or standard care. The primary outcome was a composite of cardiac death, myocardial infarction, or recurrent cardiac admission.
A post hoc subgroup analysis evaluated patients in the PET arm with complete baseline data, confirmed obstructive CAD, and interpretable PET scans, to assess the interaction of hibernation and outcome benefit from revasc.
Results: After five years, 112 (51% of enrolled) patients in the PET arm, and 119 (56%) patients in the standard care arm experienced the composite event (hazard ratio, (HR) for the composite event 0.818, 95% CI 0.629 to 1.062, p=0.13). When only patients who adhered to the recommendation of the PET scan were included the HR for the time to the primary outcome was 0.725 (95% CI 0.540 to 0.973, p=0.032).
Among 182 patients from the PET arm, there was a significant interaction between hibernation and outcome, with ≥4% LV hibernation associated with benefit from revasc.
Conclusions: While the primary intention to treat analysis remains negative, post-hoc analysis continues to suggest that with adherence to the imaging recommendation, use of FDG PET to direct revascularization may improve long-term outcomes. Furthermore, the extent of myocardial hibernation remains a robust predictor of response to revascularization.
- Positron emission tomography
- Ischemic heart disease
- Heart failure
- Coronary artery bypass grafting (CABG)
Author Disclosures: B.A. Mc Ardle: None. T. Shukla: None. J. Bernick: None. R.A. Davies: None. L. Duchesne: None. T. Ruddy: None. B. Chow: Other Research Support; Significant; GE Healthcare, Tera Recon. H. Haddad: None. L. Garrard: None. L. Higginson: None. P. Hendry: None. R. Masters: None. D. Humen: None. M. Freeman: None. K. Gulenchyn: None. F. Benard: None. N. Racine: None. G.A. Wells: None. G. Nichol: None. R.S. Beanlands: Research Grant; Modest; Nordion, GE Healthcare, Jubilant DRAXImage. Consultant/Advisory Board; Modest; Jubilant Drax Image. Consultant/Advisory Board; Significant; GE Healthcare, Lantheus Medical Imaging.
- © 2014 by American Heart Association, Inc.