Prognostic value of cardiac-dedicated cadmium-zinc-telluride- single-photon emission computed tomography dynamic imaging derived myocardial blood flow quantification parameters in post-percutaneous coronary intervention acute myocardial infarction patients: A pilot study.

BACKGROUND

This study aims to assess the prognostic significance of myocardial blood flow (MBF) quantification parameters obtained through cadmium-zinc-telluride (CZT)-single-photon emission computed tomography (SPECT) in post-percutaneous coronary intervention (post-PCI) acute myocardial infarction (AMI) patient population.

METHODS

A prospective cohort comprising 144 AMI patients who underwent primary PCI was enrolled. All participants received PCI within 12 hours of AMI diagnosis and subsequently underwent cardiac-dedicated CZT-SPECT dynamic imaging within two weeks post procedure. Quantitative MBF parameters, semiquantitative perfusion scores, and left ventricular functional parameters were collected. Major adverse cardiovascular events (MACEs) were defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, heart failure, late coronary revascularization, or hospitalization due to unstable angina.

RESULTS

Over a median follow-up duration of 27 months (interquartile range: 15-37), a total of 40 MACEs were observed. Stress myocardial blood flow (sMBF) (P < 0.001) and myocardial flow reserve (MFR) (P = 0.002) were significantly lower in patients with MACEs. Receiver operating characteristic analysis determined optimal prognostic thresholds: sMBF <1.39 (area under the curve [AUC]: 0.67, 95% confidence interval [CI]: 0.58-0.76, sensitivity: 46.2%, specificity: 90.0%, P < 0.001) and MFR <1.84 (AUC: 0.66, 95% CI: 0.57-0.75, sensitivity: 44.2%, specificity: 90.0%, P < 0.01). The Kaplan-Meier survival analysis demonstrated significantly diminished event-free survival in patients exhibiting impaired sMBF (log-rank = 14.67; P < 0.0001) or MFR (log-rank = 12.98; P = 0.0003).

CONCLUSIONS

CZT-SPECT MBF quantification provides substantial prognostic value for post-PCI AMI patients. Importantly, stress-induced sMBF and MFR were identified as independent predictors of MACEs, demonstrating enhanced diagnostic efficacy over traditional semiquantitative perfusion parameters.