Elsemiek M Engbers1, Jorik R Timmer2, Jan Paul Ottervanger2, Mohamed Mouden2, Siert Knollema2, Pieter L Jager2. 1. From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands. e.engbers@isala.nl. 2. From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands.
Abstract
BACKGROUND: The prognostic value of coronary artery calcium (CAC) scoring on top of myocardial perfusion imaging with single-photon emission computed tomography (SPECT) in patients suspected for coronary artery disease is not well established. METHODS AND RESULTS: Four thousand eight hundred ninety-seven symptomatic patients without a history of coronary artery disease referred for SPECT and CAC scoring were included. Major adverse cardiac events (MACEs) were defined as late revascularization (>90 days after scanning), nonfatal myocardial infarction, and all-cause mortality. The frequency of abnormal SPECT increased with higher CAC scores, from 12% in patients with CAC scores of 0 to 19%, 32%, 37%, and 50% among those with CAC scores 1 to 99, 100 to 399, 400 to 999, and ≥1000, respectively (P<0.001). During a median follow-up of 940 days (25th to 75th percentile, 581-1377), a total of 278 MACEs were observed. Overall incidence of MACE was 2.3% per year. A stepwise increase of MACE was present with increasing CAC scores, both in patients with normal SPECT (annual event rate CAC score 0: 0.6%; CAC score ≥1000: 5.5%) and abnormal SPECT (annual event rate CAC score 0: 0.4%; CAC score ≥1000: 7.6%). After multivariate analysis, both SPECT and CAC score were independent predictors of MACE (CAC score ≥1000: hazard ratio, 7.7; P<0.001 and large perfusion defect on SPECT: hazard ratio, 3.7; P<0.001). CONCLUSIONS: CAC score and SPECT are independent predictors of MACE in patients suspected for coronary artery disease. Our findings strongly support performing a CAC score in addition to SPECT in symptomatic patients to better define the risk of events during follow-up.
BACKGROUND: The prognostic value of coronary artery calcium (CAC) scoring on top of myocardial perfusion imaging with single-photon emission computed tomography (SPECT) in patients suspected for coronary artery disease is not well established. METHODS AND RESULTS: Four thousand eight hundred ninety-seven symptomatic patients without a history of coronary artery disease referred for SPECT and CAC scoring were included. Major adverse cardiac events (MACEs) were defined as late revascularization (>90 days after scanning), nonfatal myocardial infarction, and all-cause mortality. The frequency of abnormal SPECT increased with higher CAC scores, from 12% in patients with CAC scores of 0 to 19%, 32%, 37%, and 50% among those with CAC scores 1 to 99, 100 to 399, 400 to 999, and ≥1000, respectively (P<0.001). During a median follow-up of 940 days (25th to 75th percentile, 581-1377), a total of 278 MACEs were observed. Overall incidence of MACE was 2.3% per year. A stepwise increase of MACE was present with increasing CAC scores, both in patients with normal SPECT (annual event rate CAC score 0: 0.6%; CAC score ≥1000: 5.5%) and abnormal SPECT (annual event rate CAC score 0: 0.4%; CAC score ≥1000: 7.6%). After multivariate analysis, both SPECT and CAC score were independent predictors of MACE (CAC score ≥1000: hazard ratio, 7.7; P<0.001 and large perfusion defect on SPECT: hazard ratio, 3.7; P<0.001). CONCLUSIONS: CAC score and SPECT are independent predictors of MACE in patients suspected for coronary artery disease. Our findings strongly support performing a CAC score in addition to SPECT in symptomatic patients to better define the risk of events during follow-up.
Authors: Sharmila Dorbala; Karthik Ananthasubramaniam; Ian S Armstrong; Panithaya Chareonthaitawee; E Gordon DePuey; Andrew J Einstein; Robert J Gropler; Thomas A Holly; John J Mahmarian; Mi-Ae Park; Donna M Polk; Raymond Russell; Piotr J Slomka; Randall C Thompson; R Glenn Wells Journal: J Nucl Cardiol Date: 2018-10 Impact factor: 5.952
Authors: Ami E Iskandrian; Vasken Dilsizian; Ernest V Garcia; Rob S Beanlands; Manuel Cerqueira; Prem Soman; Daniel S Berman; Alberto Cuocolo; Andrew J Einstein; Charity J Morgan; Fadi G Hage; Heinrich R Schelbert; Jeroen J Bax; Joseph C Wu; Leslee J Shaw; Mehran M Sadeghi; Nagara Tamaki; Philipp A Kaufmann; Robert Gropler; Sharmila Dorbala; William Van Decker Journal: J Nucl Cardiol Date: 2017-11-06 Impact factor: 5.952