In general, the best way to determine the cause of death is autopsy. Most of our patients, however, aren’t willing to undergo this procedure in order to guide preventative care. Thus, we are left using imprecise predictive instruments to prognosticate and prevent untimely demise.
In the cardiovascular sciences, a large part of what we do is salvage – catheterization, stenting, and cardiovascular care units to minimize myocardial injury after infarction. These authors, however, believe they’ve identified a new paradigm in cardiovascular imaging: identification of individual high-risk atherosclerotic plaques.
In this observational cross-sectional study, the authors enrolled 40 patients immediately following myocardial infarction and 40 patients with known stable angina. All patients underwent combined PET and CT with radioactive tracers. In 37/40 post-MI patients, the culprit lesion had significantly higher radioactive uptake compared with all non-culprit lesions. Extending this observation to the 40 patients with stable angina, 18/40 had lesions associated with similar radioactive tracer uptake compared to background. Patients with these lesions underwent intravascular ultrasound, which confirmed high-risk features such as remodeling, microcalcifications, and necrotic cores.
This is light-years away from being validated, and then being further translated into routine care – but it is quite fascinating work. We’ve bemoaned the limitations of our non-invasive imaging, based on our inability to characterize lesion histology or adequacy of tissue perfusion from varying levels of stenosis, and this is a promising step for guiding management of a subset of high-risk patients.
“18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial”
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61754-7/abstract