Multicenter Evaluation of Myocardial Flow Reserve as a Prognostic Marker for Mortality in 13 N-Ammonia Positron Emission Tomography (PET) Myocardial Perfusion Imaging
Main finding · All-cause mortalityResult — go to the resultHazard ratio 2.70 95% CI 2.41–3.03Authors' conclusion
In this large multicenter cohort, MFR derived from 13 N-ammonia PET myocardial perfusion imaging is a strong, independent predictor of all-cause mortality, even in patients with normal perfusion. An MFR of ≤2 identifies elevated risk, while higher values are associated with improved survival. These findings support the routine integration of MFR to enhance risk stratification in patients with suspected or known coronary artery disease.
Study context
- Population
- Patients with suspected or known coronary artery disease who underwent 13 N-ammonia PET myocardial perfusion imagingpatients included, median follow-up 3.8 years
- Participants
- 6,277 patients
- Exposure
- Patients with myocardial flow reserve (MFR) ≤2 vs those with MFR >2
- MFR ≤2n = 1,895
- MFR >2n = 4,382reference
- Outcome
- All-cause mortality
- Follow-up
- Median 3.8 years
Methodological details5 sites, REFINE PET registry
- 5 sites
- REFINE PET registry
Main finding
As reported in the abstract
Hazard ratio
2.70
95% CI 2.41–3.03
P < 0.001
Events by group
Observational data: associations, not effects.
Further findings
| Outcome | Hazard ratio (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality among patients with no perfusion defects (subgroup)Multivariable | 2.36 (1.93–2.89) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Annualized all-cause mortality rates by MFR and summed stress score
- Range
- 1.7 to 15.8
Mortality risk across increasing MFR deciles
- Hazard ratio range, decreasing across increasing deciles
- 2.73 (95% CI, 2.39-3.11) to 0.35 (95% CI, 0.25-0.49)
Original publication
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