The clinical utility of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography in guiding myocardial revascularisation

Abstract

INTRODUCTION : Current myocardial revascularisation guidelines recommend that patients with acute coronary syndromes be timeously revascularised. Despite these class I recommendations, immediate access to timeous revascularisation is often not achievable in low- and middle-income countries (LMIC) and remote regions in high-income countries (HIC). Many patients present late outside of the therapeutic window for guideline-recommended interventions. 2-Deoxy-2-[18F]fluoro-d-glucose (2-[18F]FDG) is a radiopharmaceutical agent used to identify cardiac regions with viable or hibernating myocardium. Viable myocytes with impaired contraction may recover their contractility with successful myocardial revascularisation. However, there are conflicting hard outcomes data on patients with hibernating myocardium who are subsequently revascularised. Whether this management strategy results in improved major adverse cardiovascular events remains uncertain. METHODS : In this narrative review, we will critically appraise the existing body of evidence on whether using 2-[18F]FDG positron emission tomography (PET) in guiding myocardial revascularisation leads to compelling clinical outcomes or not. Furthermore, we will discuss possible reasons for the lack of differences in patient outcomes. RESULTS : A few randomised controlled trials have challenged the concept of viability testing with 2-[18F]FDG PET. One trial demonstrated that a reduction in mortality could be observed if PET recommendations are followed. CONCLUSION : The current evidence is insufficient for clinicians in LMIC or remote areas in HIC without access to catheterisation laboratories to refrain from referring patients for viability imaging.