What is the clinical evidence from this study?

Study design: Observational. Population: Previous extensive myocardial infarction (n=18). Intervention: Good epicardial filling (summed epicardial flow ≥ 3) vs. Limited epicardial flow (summed score < 3). Primary outcome: Average perfusion activity (p=0.001%).

What does this research mean for the field?

Angiographically detectable good epicardial flow has a low positive predictive value for myocardial viability assessed by PET, whereas limited flow reliably indicates scarred segments. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the predictive value of angiographically detectable epicardial flow for myocardial tissue viability post-infarction.

July 15, 2026European Heart JournalOpen Access

Segmental comparison between coronary angiography and positron emission tomography reveals low predictive value of epicardial flow for viability

Q: What are the key findings of this study?

Angiographically detectable good epicardial flow had a low positive predictive value (0.5) for PET viability, while limited flow reliably indicated scarred segments (NPV 0.82).

Q: What does this research mean for the field?

Angiographically detectable good epicardial flow has a low positive predictive value for myocardial viability assessed by PET, whereas limited flow reliably indicates scarred segments. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Good epicardial flow poorly predicts PET viability, while limited flow indicates scar with ~82% reliability.

P 0.001%
n=18

Why the study?

The functional significance of anterograde and retrograde filling of coronaries on angiography is controversial.

Does angiographically assessed epicardial flow accurately predict myocardial viability on PET in patients with previous extensive myocardial infarction?

Population

18 patients with 27 severe lesions (> 85% diameter stenosis) after previous extensive myocardial infarction

Comparison

Angiographic epicardial flow vs 13NH3- and 18FDG-PET tissue perfusion and metabolism

Design

Observational comparative study

Authors

ZKZsolt KőszegiInterventional Cardiology

Discussion

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Implication

Angiographic flow should not yet guide viability decisions post-MI; leaves open need for prospective validation of integrated imaging.

Key Points

To assess the predictive value of angiographically detectable epicardial flow for myocardial tissue viability post-infarction.
Eighteen patients with 27 severe lesions were selected post-myocardial infarction.
The left ventricle was divided into 33 segments for analysis of epicardial flow and perfusion using PET and angiography.
Epicardial flow was graded by TIMI criteria and registered on a polar map.
Higher average perfusion and metabolic activities were found in segments with good epicardial filling: 65.4% vs 45.6% for perfusion (P=0.001), and 68.6% vs 47.4% for metabolism (P=0.0004).
The positive predictive value of good epicardial flow for viability was low at 0.5, while the negative predictive value was higher at 0.82.

Study Design

Type

Observational (n=18)

Structured PICO

Does angiographically assessed epicardial flow accurately predict myocardial viability on PET in patients with previous extensive myocardial infarction?

Population

18 patients with previous extensive myocardial infarction and severe coronary lesions evaluated by angiography and PET.

Exposure

Coronary angiography to assess epicardial flow (TIMI flow and retrograde collateral grade)

Comparator

13NH3- and 18FDG-Positron Emission Tomography (PET) to assess tissue perfusion and metabolism (viability)

Outcome

Predictive value of epicardial flow for myocardial viability (defined as normal perfusion or mismatch defect on PET)surrogate

Main Result

Absolute Event Rate: 65.4% vs 45.6%

p-value: p=0.001%

In patients with prior extensive myocardial infarction, good epicardial flow on angiography has a low positive predictive value for myocardial viability, indicating it does not reliably reflect nutritive function.

Cite This Study

Zsolt Kőszegi (1998) conducted an observational in Previous extensive myocardial infarction (n=18). Good epicardial filling (summed epicardial flow ≥ 3) vs. Limited epicardial flow (summed score < 3) was evaluated on Average perfusion activity (p=0.001%). Angiographically detectable good epicardial flow had a low positive predictive value (0.5) for PET viability, while limited flow reliably indicated scarred segments (NPV 0.82).

synapsesocial.com/papers/6a57a4eaee6637ed4bfa7867 https://doi.org/10.1053/euhj.1997.0856

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Segmental comparison between coronary angiography and positron emission tomography reveals low predictive value of epicardial flow for viability

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Segmental comparison between coronary angiography and positron emission tomography reveals low predictive value of epicardial flow for viability

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

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