PET technology more effective than angiogram in determining the need for coronary stents, bypass surgery

A new method for determining whether heart disease patients need coronary stenting or bypass surgery is more effective than the angiogram, which is currently used, according to research by UTHealth Houston Heart & Vascular.

A team led by K. Lance Gould, MD, professor and Martin Bucksbaum Distinguished University Chair in Heart Disease at McGovern Medical School at UTHealth Houston, used positron emission tomography (PET) imaging technology to map blood flow coronary artery and its findings, namely, subendocardial ischemia – among patients with heart disease. The study was published in JACC magazines.

Most heart disease causes damage to the myocardium. Myocardial ischemia occurs when blood flow to the heart is reduced, preventing the heart muscle from getting enough oxygen. When myocardial ischemia affects the deep, or subendocardial, layer of left ventricular muscle, it is known as subendocardial ischemia.

Subendocardial ischemia is commonly diagnosed in patients with cardiovascular disease, but is not quantified by current imaging tools. Gould’s team developed the PET technology, software and clinical validation to define the size and severity of this early stage of coronary artery disease.

“The cumulative data reveal that all randomized trials of coronary stenting and bypass surgery have failed to improve survival after revascularization due to deeply flawed angiogram-based patient selection,” said Gould, who was the first author of the study. “Therefore, coronary angiography is not the gold standard for determining stents or bypass surgery, but rather quantitative myocardial perfusion by PET is the gold standard.”

Significantly, the paper confirmed the team’s previous research, demonstrating the PET severity threshold at which stents and bypass surgery improve survival compared to medical treatment alone. The angiogram — an X-ray test that helps doctors evaluate blockages in the arterial system — shows stents or surgical bypasses to be done, Gould said, but not whether such procedures should be done at all.

Gould, who began at UTHealth Houston in 1979 as a professor and division director of cardiology, stepped away from administrative duties in 1987 to focus clinically and scientifically on PET imaging and quantitative coronary arteriography to identify segmental coronary artery disease and widespread, measure its severity and reverse it by vigorous modification of risk factors.

“Several equally paradigmatic papers are underway for next year,” Gould said. “For example, our preliminary data show that virtual revascularization on cardiac PET images predicts survival outcomes before actually performing stenting or bypass surgery, as a guide for making decisions for or against such procedures.”

Nils P. Johnson, MD, MS, professor and Weatherhead Distinguished Chair of Heart Disease at McGovern Medical School, was the study’s senior author. Other co-authors from McGovern Medical School’s Division of Cardiovascular Medicine included Tung Nguyen, BS; Richard Kirkeeide, PhD; Amanda E. Roby, CNMT, RT(N); Linh Bui, MD; Danai Kitkungvan, MD; Monica B. Patel, MD; Mohammad Madjid, MD; and Mary Haynie, RN, MBA. Coauthors with UTHealth Houston School of Public Health included Dejian Lai, PhD, and Ruosha Li, PhD. Jagat Narula, MD, PhD, with Mount Sinai Heart at Mount Sinai Morningside and Icahn School of Medicine at Mount Sinai in New York, also contributed to the study.

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