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No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomography-guided patient management

A prospective, randomized comparison of patients with suspicion of jeopardized myocardium

Hans-Marc J. Siebelink, MD^*, Paul K. Blanksma, MD, PhD^*, Harry J. G. M. Crijns, MD, PhD^*, Jeroen J. Bax, MD, PhD, Ad J. van Boven, MD, PhD^*, Tsjerk Kingma, MSc, D. Albertus Piers, MD, PhD, Jan Pruim, MD, PhD^||, Piet L. Jager, MD, PhD, Willem Vaalburg, PhD^|| and Ernst E. van der Wall, MD, PhD, FACC

^* Thorax Center, Department of Cardiology, Groningen University Hospital, Groningen, Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
Trial Coordination Center, Groningen University Hospital, Groningen, Netherlands
Department of Nuclear Medicine, Groningen University Hospital, Groningen, Netherlands
^|| PET Center, Groningen University and Groningen University Hospital, Groningen, The Netherlands

View larger version (20K): [in a new window]   Figure 1 Example of a uniform, blinded polar map consisting of a frame in which areas of jeopardized and nonviable myocardium could be depicted by using a computer. A separate polar map was created for PET results and SPECT results by different physicians. After randomization, only the polar map of the technique which the patient was randomized to receive was presented to the clinicians, who subsequently determined treatment. By using this uniform polar map design, the clinicians were completely unaware whether the polar map showed PET or SPECT results. ANT = anterior; INF = inferior; LAT = lateral; SEP = septal.

View larger version (15K): [in a new window]   Figure 2 Kaplan-Meier cardiac event-free survival curves for patients randomized to 13N-ammonia/18FDG PET or stress/rest 99mTc-sestamibi SPECT-based management (PTCA, CABG or drug therapy). All patients were potential candidates for revascularization, and in all patients, assessment of jeopardized myocardium was indicated. CABG = coronary artery bypass graft surgery; 18FDG = 18fluorodeoxyglucose; PET = positron emission tomography; PTCA = percutaneous transluminal angioplasty; SPECT = single-photon emission computed tomography.

View larger version (15K): [in a new window]   Figure 3 Kaplan-Meier cardiac event-free survival curves for patients intended to undergo revascularization on the basis of 13N-ammonia/18FDG PET or stress/rest 99mTc-sestamibi SPECT imaging. CABG = coronary artery bypass graft surgery; 18FDG = 18fluorodeoxyglucose; PET = positron emission tomography; PTCA = percutaneous transluminal angioplasty; SPECT = single-photon emission computed tomography.

View larger version (15K): [in a new window]   Figure 4 Kaplan-Meier cardiac event-free survival curves for patients intended to be treated with drugs on the basis of 13N-ammonia/18FDG PET or stress/rest 99mTc-sestamibi SPECT imaging.