Impact of Positron Emission Tomography Viability Imaging: Guided Revascularizations on Clinical Outcomes in Patients With Myocardial Scar on Single-Photon Emission Computed Tomography Scans

Background: Positron emission tomography (PET) viability scan is used to determine whether patients with a myocardial scar on single-photon emission computed tomography (SPECT) may need revascularization.However, the clinical utility of revascularization decision-making guided by PET viability imaging has not been proven yet.The purpose of this study was to investigate the impact of PET to determine revascularization on clinical outcomes.Methods: Between September 2012 and May 2021, 53 patients (37 males; mean age = 64 11 years) with a myocardial scar on MIBI SPECT who underwent PET viability test were analyzed in this study.The primary outcome was a temporal change in echocardiographic findings.The secondary outcome was all-cause mortality.Results: Viable myocardium was presented by PET imaging in 29 (54.7%)patients.Revascularization was performed in 26 (49.1%) patients, including 18 (34.0%)with percutaneous coronary intervention (PCI) and 8 (15.1%) with coronary artery bypass grafting.There were significant improvements in echocardiographic findings in the revascularization group and the viable myocardium group.All-cause mortality was significantly lower in the revascularization group than in the medical therapy-alone group (19.2% vs. 44.4%,log-rank P = 0.002) irrespective of viable (21.4% vs. 46.7%,log-rank P = 0.025) or non-viable myocardium (16.7% vs. 41.7%,log-rank P = 0.046).All-cause mortality was significantly lower in the PCI group than in the medical therapy-alone group (11.1% vs. 44.4%,log-rank P < 0.001).Conclusion: Revascularization improved left ventricular systolic function and survival of patients with a myocardial scar on SPECT scans, irrespective of myocardial viability on PET scans.