Coronary 18F-sodium fluoride PET detects high-risk plaque features on optical coherence tomography and CT-angiography in patients with acute coronary syndrome

Molecular imaging for risk prediction of coronary artery disease: A close or far fetched option?

“…Conversely, in a cohort of clinically stable patients infected with HIV, of whom 56% had diabetes mellitus, 78% showed high coronary artery NaF uptake [11]. In the paper by Majeed et al [1], age, male sex and prescription of calcium antagonists were associated with NaF in univariable analyses and only age and use of calcium antagonists remained associated in multivariable analyses. Diabetes and all other known risk factors were equally prevalent in patients with and without high NaF.…”

“…Molecular imaging for atherosclerosis has been the focus of mounting interest and research over the past several years, but it has not yet reached its full potential. In the current issue of the journal, Majeed et al [1] report an interesting correlation between molecular and anatomical imaging data. In 62 patients admitted to the hospital with a diagnosis of acute coronary syndrome (ACS), the investigators performed multivessel optical coherence tomography (OCT) imaging at the time of invasive coronary angiography to acquire intravascular details of plaque instability.…”

“…What does this all mean? Majeed et al [1] state that they were interested in "the potential application to patient-level risk stratification" of molecular imaging modalities. Have these results brought us closer to the utilization of molecular imaging in clinical practice?…”

“…The natural extension of this observation is a desire to establish NaF as a method to identify patients at risk of future events while still asymptomatic. This requires the ascertainment of two basic facts: [1] NaF accumulates in the context of plaques that exhibit known characteristics of instability at risk of sudden rupture, and [2] NaF uptake is higher in asymptomatic patients that are at high risk of future events. The study by Majeed et al [1] addressed the first of these two principles.…”

“…This requires the ascertainment of two basic facts: [1] NaF accumulates in the context of plaques that exhibit known characteristics of instability at risk of sudden rupture, and [2] NaF uptake is higher in asymptomatic patients that are at high risk of future events. The study by Majeed et al [1] addressed the first of these two principles. However, the data were again accrued in patients suffering an acute coronary syndrome (ACS), for the obvious reason that OCT is an invasive procedure and cannot be offered to asymptomatic subjects.…”