Advertisement
Canadian Journal of Cardiology

LONG TERM FOLLOW UP OF OUTCOMES WITH F-18-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY IMAGING- ASSISTED MANAGEMENT OF PATIENTS WITH SEVERE LEFT VENTRICULAR DYSFUNCTION SECONDARY TO CORONARY DISEASE: 5-YEAR FOLLOW-UP OF THE PARR-2 RANDOMIZED CONTROLLED TRIAL

      Background

      PARR-2 randomized patients with presumed ischemic cardiomyopathy being considered for revascularization to PET-guided vs. standard care. After one year of follow up, the PET group tended to have improved outcome (death, infarction or cardiac admission). Herein we present results after 5 years of follow up.

      Methods

      Included patients had LV ejection fraction of </=35% due to CAD and were being considered for revascularization, or where FDG PET was considered to be of potential value by the treating physician. Patients were randomized to either an FDG PET scan or to standard care, stratified by whether or not the patient had undergone recent angiography. The primary outcome was a composite of cardiac death, myocardial infarction, or recurrent cardiac admission.

      Results

      After five years, 112 (51% of enrolled) patients in the PET arm, and 119 (56%) patients in the standard care arm experienced the composite event (hazard ratio (HR) for the composite event 0.818, 95% CI 0.629 to 1.062, p=0.13). When only patients who adhered to the recommendation of the PET scan were included the HR for the time to the primary outcome was 0.725 (95% CI 0.540 to 0.973, p=0.032).

      Conclusion

      The results of the initial PARR-2 study remain consistent after 5 years of follow up. While the primary intention to treat analysis remains negative, post-hoc analysis continues to suggest that when adherence to the imaging recommendation can be achieved, use of FDG PET to direct revascularization vs medical therapy alone may improve outcomes.
      Figure thumbnail fx1
      CIHR, ORDCF