Long-term Prognostic Value of Sequential Coronary CT Angiography and Quantitative Positron Emission Tomography (PET) in Suspected Chronic Coronary Syndromes: A Multicentre study
Authors' conclusion
A sequential strategy combining CCTA and quantitative [15O]H2O PET provides robust and incremental long-term risk stratification. While PET-derived ischaemia refines prediction of short-term and symptom-driven events, CCTA-derived CAD remains the principal determinant of long-term hard outcomes.
Study context
- Population
- Symptomatic patients with first symptoms suggestive of obstructive coronary artery disease (CAD), who first underwent coronary computed tomography angiography (CCTA)61.0±9.8 years, 54.3% female
- Participants
- 3,918 patients
- Exposure
- CCTA-PET categories compared to normal CCTA; among patients with obstructive CAD on CCTA, with vs without PET-derived ischaemia
- Outcome
- Composite of:
- All-cause mortality
- Non-fatal myocardial infarction (MI)
- Hospitalization for unstable angina (UA)
- Follow-up
- Median 5.1 [3.8-8.0] years
Methodological detailsselectively referred to quantitative [15O]H2O PET in case of suspected obstructive stenosis (≥50%)
- Selectively referred to quantitative [15O]H2O PET in case of suspected obstructive stenosis (≥50%)
Main finding
As reported in the abstract
Adjusted hazard ratio (95% CI)P value
Non-obstructive CAD on CCTAvs Normal CCTA
1.89(1.23–2.91)
P = 0.004Obstructive CAD on CCTA without ischaemiavs Normal CCTA
3.20(1.95–5.25)
P < 0.001Obstructive CAD on CCTA with ischaemiavs Obstructive CAD on CCTA without ischaemiaamong patients with obstructive CAD on CCTA
1.55(1.05–2.30)
P = 0.029- Patients who experienced the primary endpoint
- 278 (7.1%)
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| Composite endpoint excluding UAObstructive CAD on CCTA with ischaemiavs Obstructive CAD on CCTA without ischaemiaAmong patients with obstructive CAD on CCTA | 1.37 (0.90–2.07) | P = 0.141 | |
| 0.512Adjusted hazard ratio (log scale) |
Events by time and imaging finding
- PET-derived ischaemia primarily predicted events within the first year, while obstructive CCTA findings remained associated with long-term hard outcomes
Original publication
Long-term Prognostic Value of Sequential Coronary CT Angiography and Quantitative PET in Suspected Chronic Coronary Syndromes: A Multicentre study. Eur Heart J Cardiovasc Imaging. Published 4 November 2026. doi:10.
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