Relationship and prognostic value of coronary artery calcification by electron beam computed tomography to stress-induced ischemia by single photon emission computed tomography

Ramakrishna, Gautam; Miller, Todd D.; Breen, Jerome F.; Araoz, Philip A.; Hodge, David O.; Gibbons, Raymond J.

doi:10.1016/j.ahj.2007.02.020

Cited by 61 publications

(33 citation statements)

References 20 publications

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“…Current results are in concordance with previous findings. 4,14,15 Interestingly, after adjustment for CAC score, other known risk factors for CAD, such as age, diabetes mellitus, and hypertension, were no longer associated with abnormal SPECT. This indicates that CAC score is a stronger predictor for abnormal SPECT than more traditional risk factors for CAD.…”

Section: Discussionmentioning

confidence: 96%

“…This finding has been demonstrated before in asymptomatic patients, although the reported frequencies of normal SPECT vary considerably. 3,4,16 On the other end of the spectrum, 12% of patients with CAC score 0 showed abnormal perfusion. This incomplete agreement between CAC and SPECT could be explained by different mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…Conflicting results about the additive prognostic value of CAC score in addition to SPECT have been published. In a study by Ramakrishna et al, 4 it was first demonstrated that CAC score and SPECT provided complementary prognostic information. This was confirmed in a study by Chang et al, 3 which demonstrated that asymptomatic patients with CAC score >400 had a 3.55-fold higher risk of events (revascularization, myocardial infarction, or death) compared with patients with CAC score <10, irrespective of 16 This discrepancy is probably caused by the lower risk profile and relatively shorter follow-up period in the latter study.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 However, in symptomatic patients, the prognostic value of CAC scoring on top of SPECT imaging is less well established. The aim of the current study was to investigate the prognostic value of CAC score as an adjunct to SPECT in a low-to intermediate-risk population suspected for stable coronary artery disease.…”

Section: See Editorial By Rozanski Et Al See Clinical Perspectivementioning

confidence: 99%

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Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Engbers

Timmer

Ottervanger

et al. 2016

Circ: Cardiovascular Imaging

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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.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: See Editorial By Rozanski Et Al See Clinical Perspectivementioning

confidence: 99%

See 2 more Smart Citations

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Engbers

Timmer

Ottervanger

et al. 2016

Circ: Cardiovascular Imaging

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show abstract

“…A normal MPI study is associated with a low event rate for 2-3 y even in the presence of extensive coronary artery calcification (79). However, a high calcium score may identify a higher risk in symptomatic subjects and during longterm follow-up (81,98,99). These findings suggest the safety of an aggressive medical management strategy with repeated MPI in 2-3 y, as well as caution regarding referral to invasive coronary angiography.…”

Section: Coronary Artery Calcium Scoring and Mpimentioning

confidence: 99%

SNMMI/ASNC/SCCT Guideline for Cardiac SPECT/CT and PET/CT 1.0

et al. 2013

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Association of Coronary Artery Calcium With Severity of Myocardial Ischemia in Left Anterior Descending, Left Circumflex, and Right Coronary Artery Territories

Lai

Holtzman

Aronow

et al. 2011

Clinical Cardiology

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Background: An increasing coronary artery calcium score is associated with a higher likelihood of myocardial ischemia. Hypothesis: The association of the coronary calcium score with myocardial ischemia in different coronary arteries needed to be investigated. Methods: We correlated the coronary artery calcium (CAC) score with the severity of myocardial ischemia diagnosed by myocardial perfusion imaging in the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) territories in 206 patients, mean age 66 years, without cardiac stents or coronary artery surgery. Results: The mean CAC score in the LAD coronary artery was 160 ± 218 in patients with no or mild ischemia and 336 ± 379 in patients with moderate or severe ischemia (P = 0.039). The mean CAC score in the LCX coronary artery was 57 ± 117 in patients with no or mild ischemia and 161 ± 191 in patients with moderate or severe ischemia (P = 0.018). The mean CAC score in the RCA was 114 ± 237 in patients with no or mild ischemia and 261 ± 321 in patients with moderate or severe ischemia (P = 0.045). Stepwise linear regression analysis showed that male gender (P < 0.0001), age (P < 0.0001), and moderate or severe ischemia (P = 0.023) were significantly associated with high LAD coronary artery CAC scores. Male gender (P < 0.0001), age (P = 0.0002), and moderate or severe ischemia (P = 0.006) were significantly associated with high LCX coronary artery CAC scores. Male gender (P < 0.0001) and age (P < 0.0001) were significantly associated with high RCA CAC scores. Conclusions: Higher CAC scores are significantly associated with moderate or severe ischemia in the LAD and LCX coronary arteries.

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Relationship and prognostic value of coronary artery calcification by electron beam computed tomography to stress-induced ischemia by single photon emission computed tomography

Cited by 61 publications

References 20 publications

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

SNMMI/ASNC/SCCT Guideline for Cardiac SPECT/CT and PET/CT 1.0

Association of Coronary Artery Calcium With Severity of Myocardial Ischemia in Left Anterior Descending, Left Circumflex, and Right Coronary Artery Territories

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