RT Journal Article
SR Electronic
T1 <sup>18</sup>F-FDG PET Imaging of Myocardial Viability in an Experienced Center with Access to <sup>18</sup>F-FDG and Integration with Clinical Management Teams: The Ottawa-FIVE Substudy of the PARR 2 Trial
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 567
OP 574
DO 10.2967/jnumed.109.065938
VO 51
IS 4
A1 Arun Abraham
A1 Graham Nichol
A1 Kathryn A. Williams
A1 Ann Guo
A1 Robert A. deKemp
A1 Linda Garrard
A1 Ross A. Davies
A1 Lloyd Duchesne
A1 Haissam Haddad
A1 Benjamin Chow
A1 Jean DaSilva
A1 Rob S.B. Beanlands
A1 for the PARR 2 Investigators
YR 2010
UL http://jnm.snmjournals.org/content/51/4/567.abstract
AB 18F-FDG PET may assist decision making in ischemic cardiomyopathy. The PET and Recovery Following Revascularization (PARR 2) trial demonstrated a trend toward beneficial outcomes with PET-assisted management. The substudy of PARR 2 that we call Ottawa-FIVE, described here, was a post hoc analysis to determine the benefit of PET in a center with experience, ready access to 18F-FDG, and integration with clinical teams. Methods: Included were patients with left ventricular dysfunction and suspected coronary artery disease being considered for revascularization. The patients had been randomized in PARR 2 to PET-assisted management (group 1) or standard care (group 2) and had been enrolled in Ottawa after August 1, 2002 (the date that on-site 18F-FDG was initiated) (n = 111). The primary outcome was the composite endpoint of cardiac death, myocardial infarction, or cardiac rehospitalization within 1 y. Data were compared with the rest of PARR 2 (PET-assisted management [group 3] or standard care [group 4]). Results: In the Ottawa-FIVE subgroup of PARR 2, the cumulative proportion of patients experiencing the composite event was 19% (group 1), versus 41% (group 2). Multivariable Cox proportional hazards regression showed a benefit for the PET-assisted strategy (hazard ratio, 0.34; 95% confidence interval, 0.16–0.72; P = 0.005). Compared with other patients in PARR 2, Ottawa-FIVE patients had a lower ejection fraction (25% ± 7% vs. 27% ± 8%, P = 0.04), were more often female (24% vs. 13%, P = 0.006), tended to be older (64 ± 10 y vs. 62 ± 10 y, P = 0.07), and had less previous coronary artery bypass grafting (13% vs. 21%, P = 0.07). For patients in the rest of PARR 2, there was no significant difference in events between groups 3 and 4. The observed effect of 18F-FDG PET–assisted management in the 4 groups in the context of adjusted survival curves demonstrated a significant interaction (P = 0.016). Comparisons of the 2 arms in Ottawa-FIVE to the 2 arms in the rest of PARR 2 demonstrated a trend toward significance (standard care, P = 0.145; PET-assisted management, P = 0.057). Conclusion: In this post hoc group analysis, a significant reduction in cardiac events was observed in patients with 18F-FDG PET–assisted management, compared with patients who received standard care. The results suggest that outcome may be benefited using 18F-FDG PET in an experienced center with ready access to 18F-FDG and integration with imaging, heart failure, and revascularization teams.