Prognostic value of global myocardial flow reserve in patients with history of coronary artery bypass grafting

Mahmoud Al Rifai, Ahmed Ibrahim Ahmed, Jean Michel Saad, Fares Alahdab, Faisal Nabi, Mouaz H. Al-Mallah

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


AIMS: It is not well understood whether positron emission tomography (PET)-derived myocardial flow reserve (MFR) is prognostic among patients with prior coronary artery bypass grafting (CABG).

METHODS AND RESULTS: Consecutive patients with a clinical indication for PET were enrolled in the Houston Methodist DeBakey Heart and Vascular Center PET registry and followed prospectively for incident outcomes. The primary outcome was a composite of all-cause death, myocardial infarction (MI)/unplanned revascularization, and heart failure admissions. Cox proportional hazards models were used to study the association between MFR (<2 vs. ≥2) and incident events adjusting for clinical and myocardial perfusion imaging variables. The study population consisted of 836 patients with prior CABG; mean (SD) age 68 (10) years, 53% females, 79% Caucasian, 36% non-Hispanic, and 66% with MFR <2. Over a median (interquartile range [IQR]) follow-up time of 12 (4-24) months, there were 122 incident events (46 HF admissions, 28 all-cause deaths, 23 MI, 22 PCI/3 repeat CABG 90 days after imaging). In adjusted analyses, patients with impaired MFR had a higher risk of the primary outcome [hazard ratio (HR) 2.06; 95% CI 1.23-3.44]. Results were significant for admission for heart failure admissions (HR 2.92; 95% CI 1.11-7.67) but not for all-cause death (HR 2.01, 95% CI 0.85-4.79), or MI/UR (HR 1.93, 95% CI 0.92-4.05).

CONCLUSION: Among patients with a history of CABG, PET-derived global MFR <2 may identify those with a high risk of subsequent cardiovascular events, especially heart failure, independent of cardiovascular risk factors and perfusion data.

Original languageEnglish (US)
Pages (from-to)1470-1477
Number of pages8
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number11
StatePublished - Nov 1 2023


  • coronary artery bypass graft
  • myocardial flow reserve
  • myocardial perfusion imaging
  • positron emission tomography
  • Percutaneous Coronary Intervention/adverse effects
  • Myocardial Perfusion Imaging/methods
  • Prognosis
  • Humans
  • Male
  • Heart Failure/etiology
  • Coronary Artery Disease/diagnostic imaging
  • Myocardial Infarction/etiology
  • Female
  • Aged
  • Coronary Artery Bypass/adverse effects

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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