Prediction of Recurrent Events with 18F-Fluoride to Identify Ruptured and High-risk Coronary Artery Plaques in Patients with Myocardial Infarction

Prediction of Recurrent Events with 18F-Fluoride to Identify Ruptured and High-risk Coronary Artery Plaques in Patients with Myocardial Infarction

This is a multi-centre international observational cohort study funded by the Wellcome Trust (WT103782AIA): the Prediction of Recurrent Events with 18F-Fluoride to Identify Ruptured and high-risk coronary artery plaques in patients with myocardial infarction (PRE18FFIR; NCT02278211). It is assessing whether the positron emission tomography (PET) tracer 18F-sodium fluoride is as a marker of coronary plaque vulnerability and can detect culprit and non-culprit unstable coronary plaques in patients with recent myocardial infarction.

Research Methods and Objectives:

The investigators intend to recruit 700 patients hospitalised with myocardial infarction and proven multivessel coronary artery disease. All patients will undergo a combined CT coronary angiogram (CTCA) and PET scan using 18F-NaF as a tracer. Patients will then have clinical follow-up before undergoing a repeat CTCA at 2 years to assess progression of coronary disease. Clinical review of all patients will continue until study completion (given 2 years of recruitment this is likely to last 4 years) and following this the investigators will continue to monitor for further cardiovascular events via review of patient electronic health records for a further 5 years. The primary endpoint of the trial is to determine the prognostic significance of coronary 18F-NaF uptake. It is being undertaken in 8 centres in the UK as well as centres in Australia, Singapore and the United States of America.

Invasive Coronary Angiography:

Underlying Theoretical Considerations:

 

Chief Investigator: David Newby

Co-Investigators: Marc Dweck, Nick Mills

Key Publications

  1. Joshi NV, Vesey AT, Williams MC, Shah ASV, Calvert PA, Craighead FHM, Yeoh SE, Wallace W, Salter D, Fletcher AM, van Beek EJR, Flapan AD, Uren NG, Behan MWH, Cruden NLM, Mills NL, Fox KAA, Rudd JHF, Dweck MR*, Newby DE*. 18F-Fluoride positron emission tomography identifies ruptured and high-risk coronary atherosclerotic plaques. Lancet 2014;383:705-713.
  2. Irkle A, Vesey AT, Lewis DY, Skepper JN, Bird JLE, Dweck MR, Joshi FR, Gallagher F, Warburton EA, Bennett MR, Brindle KM, Newby DE, Rudd JH, Davenport AP. Identifying active vascular microcalcification by 18F-sodium fluoride positron emission tomography. Nat Commun. 2015;6:7495.