Coronary microcalcification activity (CMA), assessed using non-invasive ¹⁸F-sodium fluoride positron emission tomography (PET) and coronary computed tomography angiography (CTA), did not predict all recurrent coronary events in patients with recent myocardial infarction (MI) and had no association with subsequent coronary revascularization, but did predict all-cause mortality and cardiac death or nonfatal MI, according to findings from the PRE¹⁸FFIR study presented Aug. 28 during ESC Congress 2022 in Barcelona.

The international, multicenter trial enrolled 704 patients (average age 64 years; 85% men) with a recent myocardial infarction (within 21 days) and multivessel coronary artery disease. The initial primary endpoint was cardiac death or nonfatal MI but was expanded during the study to include unscheduled coronary revascularization due to lower than anticipated primary event rates. All participants underwent 18F-sodium fluoride PET and CTA, and CMA was determined by an independent blinded core laboratory. Median follow up was four years, with a minimum of two years. All told, 421 patients had CMA=>0 and 283 patients had CMA=0.

Researchers said the composite primary endpoint occurred in 51 patients (18%) in the CMA=0 group and 90 patients (21%) in the CMA>0 group. Additionally, they noted that increased coronary atherosclerotic plaque activity was not associated with the primary endpoint, largely due to the lack of an association with unscheduled coronary revascularization. Secondary analyses found increased coronary atherosclerotic plaque activity was associated with all-cause mortality and with the original primary endpoint of cardiac death or nonfatal MI.

In presenting the study results, David E. Newby, MD, FACC, said: "These findings indicate that coronary atherosclerotic plaque activity predicts spontaneous recurrent atherothrombotic events. CMA assessment could guide the application of more intensive lipid-lowering, anti-inflammatory or other advanced therapies to prevent recurrent spontaneous atherothrombotic events."

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Interventions and Coronary Artery Disease, Interventions and Imaging, Computed Tomography, Nuclear Imaging

Keywords: ESC Congress, ESC22, ACC International, Coronary Artery Disease, Sodium Fluoride, Plaque, Atherosclerotic, Computed Tomography Angiography, Myocardial Infarction, Calcinosis, Positron-Emission Tomography, Anti-Inflammatory Agents, Lipids

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