BACKGROUND: Individuals with normal myocardial perfusion imaging (MPI) may still have substantial coronary artery disease (CAD), which would benefit from aggressive medical therapy. The role of coronary artery calcium-score (CAC) and/or coronary CT Angiography (CTA) to identify additional treatment candidates in this population is unknown. METHODS: Ninety-four patients completed the study protocol and underwent CAC and CTA after MPI. RESULTS: In 81 patients who had a normal MPI, an algorithm using the clinical predictors, CAC, and then CTA was created to identify candidates for aggressive medical management; 24/81 patients had a high Framingham Risk Score (FRS) or diabetes, and need aggressive medical management, while 6/81 patients had a low FRS and low post-MPI probability of CAD. The use of CAC in 51/81 patients with intermediate clinical predictors would identify 23/51 patients with low risk (CAC < 100) and 11/51 patients (CAC > 400) for aggressive medical management. The remaining 17/51 patients with intermediate CAC scores (100-399) would require CTA, of which, would identify 8/17 additional patients with >50% stenosis for aggressive medical therapy. CONCLUSION: A stepwise approach including history, CAC and CTA can identify about 50% of the patients with normal MPI who have a higher risk and may benefit from aggressive medical management.
BACKGROUND: Individuals with normal myocardial perfusion imaging (MPI) may still have substantial coronary artery disease (CAD), which would benefit from aggressive medical therapy. The role of coronary artery calcium-score (CAC) and/or coronary CT Angiography (CTA) to identify additional treatment candidates in this population is unknown. METHODS: Ninety-four patients completed the study protocol and underwent CAC and CTA after MPI. RESULTS: In 81 patients who had a normal MPI, an algorithm using the clinical predictors, CAC, and then CTA was created to identify candidates for aggressive medical management; 24/81 patients had a high Framingham Risk Score (FRS) or diabetes, and need aggressive medical management, while 6/81 patients had a low FRS and low post-MPI probability of CAD. The use of CAC in 51/81 patients with intermediate clinical predictors would identify 23/51 patients with low risk (CAC < 100) and 11/51 patients (CAC > 400) for aggressive medical management. The remaining 17/51 patients with intermediate CAC scores (100-399) would require CTA, of which, would identify 8/17 additional patients with >50% stenosis for aggressive medical therapy. CONCLUSION: A stepwise approach including history, CAC and CTA can identify about 50% of the patients with normal MPI who have a higher risk and may benefit from aggressive medical management.
Authors: Rory Hachamovitch; Sean Hayes; John D Friedman; Ishac Cohen; Leslee J Shaw; Guido Germano; Daniel S Berman Journal: J Am Coll Cardiol Date: 2003-04-16 Impact factor: 24.094
Authors: John S Ho; Shannon J Fitzgerald; Lisa L Stolfus; Wendy A Wade; Dale B Reinhardt; Carolyn E Barlow; John J Cannaday Journal: Am J Cardiol Date: 2008-03-17 Impact factor: 2.778
Authors: Daniel S Berman; Leslee J Shaw; Rory Hachamovitch; John D Friedman; Donna M Polk; Sean W Hayes; Louise E J Thomson; Guido Germano; Nathan D Wong; Xingping Kang; Alan Rozanski Journal: Semin Nucl Med Date: 2007-01 Impact factor: 4.446
Authors: Arthur J H A Scholte; Joanne D Schuijf; Antje V Kharagjitsingh; Petra Dibbets-Schneider; Marcel P Stokkel; J Wouter Jukema; Ernst E van der Wall; Jeroen J Bax; Frans J T Wackers Journal: J Nucl Cardiol Date: 2008-04-21 Impact factor: 5.952
Authors: Raymond J Gibbons; Jonathan Abrams; Kanu Chatterjee; Jennifer Daley; Prakash C Deedwania; John S Douglas; T Bruce Ferguson; Stephan D Fihn; Theodore D Fraker; Julius M Gardin; Robert A O'Rourke; Richard C Pasternak; Sankey V Williams; Raymond J Gibbons; Joseph S Alpert; Elliott M Antman; Loren F Hiratzka; Valentin Fuster; David P Faxon; Gabriel Gregoratos; Alice K Jacobs; Sidney C Smith Journal: Circulation Date: 2003-01-07 Impact factor: 29.690
Authors: Matthew P Ostrom; Ambarish Gopal; Naser Ahmadi; Khurram Nasir; Eric Yang; Ioannis Kakadiaris; Ferdinand Flores; Song S Mao; Matthew J Budoff Journal: J Am Coll Cardiol Date: 2008-10-14 Impact factor: 24.094
Authors: Andor W J M Glaudemans; Riemer H J A Slart; Alessandro Bozzao; Elena Bonanno; Marcello Arca; Rudi A J O Dierckx; Alberto Signore Journal: Eur J Nucl Med Mol Imaging Date: 2010-03-20 Impact factor: 9.236
Authors: Salem A Yuoness; Ahmed M Goha; Jonathan G Romsa; Cigdem Akincioglu; James C Warrington; Sudip Datta; David R Massel; Rafael Martell; Sanjay Gambhir; Jean-Luc C Urbain; William C Vezina Journal: Eur J Nucl Med Mol Imaging Date: 2015-07-04 Impact factor: 9.236