New technique identifies ‘hot’ disease in arteries that can lead to CV events

 In my obviously non-medical opinion I would think this could be repurposed to identify risks for a subsequent stroke. But since there is NO LEADERSHIP  in stroke, no one will ensure such research gets accomplished. Nothing will occur, you'll just have to accept your second stroke as inevitable since the complete stroke medical world is totally fucking incompetent.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

New technique identifies ‘hot’ disease in arteries that can lead to CV events

Using noninvasive 18F-sodium fluoride PET and coronary CTA to detect “hot” disease in arteries, researchers were able to predict which patients with recent MI would have recurrent coronary events.

PET “is often used in cancer; it uses positrons to produce a signal so you can see externally the biology of what’s going on in the body without inserting catheters,” David E. Newby, MD, British Heart Foundation Professor of Cardiology at the University of Edinburgh, U.K., said during a press conference at the European Society of Cardiology Congress. “What we’ve done is develop a technique using a slightly different tracer, 18F-sodium fluoride. What it does is bind to hardening within the coronary arteries and identify areas of active disease in the arteries. It’s not like a calcium score ... on a CT scan. This is activity of the plaque itself. This is potentially the first technique where we can actually see externally, using a PET CT scan, whether a patient’s coronary arteries are ‘hot’ and inflamed and might cause a heart attack. It’s lighting up just the area that’s got the nasty disease in it.”

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Traditionally, prediction of future CV events in patients with MI is done by the GRACE score or by an invasive angiogram to assess for narrow arteries, he said. “The problem with these things is that scores are imprecise and the angiogram looks at narrowings, but we know that most recurrent heart attacks are from artery disease that is not narrowed.”

David E. Newby

For the PRE¹⁸FFIR study, Newby and colleagues performed noninvasive 18F-sodium fluoride PET and coronary CTA on 704 patients with recent MI and multivessel disease (4% single-vessel, 55% two-vessel, 34% three-vessel, 7% left main). The clinical endpoints of interest were CHD death, MI, all-cause death and stenting or CABG. Median follow-up was 4 years.

There were 712 patients who attended the baseline visit. Six had an incomplete PET scan (three due to claustrophobia, one due to panic attack, one due to anxiety and one due to system malfunction) and two were lost to follow-up, according to the presentation.

“We showed that if we use this technique, we can actually predict the future risk of these patients of having a heart attack, of dying or of dying from heart disease in particular,” Newby said at the press conference. “What we didn’t see was whether somebody would have a stent put in.”

The patients were stratified by whether they had a lot of active disease (“hot arteries”) or not (“cold arteries”). Compared with those with cold arteries, those with hot arteries had elevated risk for CHD death/MI (HR = 1.82; 95% CI, 1.07-3.1; P = .03; log-rank P = .025) and all-cause death (HR = 2.43; 95% CI, 1.15-5.12; P = .02; log-rank P = .016), according to the researchers. There was no difference between the groups in revascularization.

“This is the first real demonstration in a robust, multicenter international study showing that we can see ‘hot’ plaques that are going to cause problems downstream,” Newby said at the press conference. “We’ve used a technique that is widely available in cancer but can now be applied readily to cardiology patients. And it picks out the people at the highest risk of a future event. It helps in terms of counseling the patient. It also helps in terms of escalating treatments, because we have an awful lot of treatments. And it also is a technique we potentially could use test new drugs against to see if we can prevent further recurrent heart attacks.”