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Updated: Jul 16, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Clinical outcomes after both coronary calcium scanning and exercise myocardial perfusion scintigraphy
Alan Rozanski1, Heidi Gransar, Nathan D Wong
1Department of Medicine, St. Luke's Roosevelt Hospital, New York, New York, USA.
Insights
High coronary artery calcium (CAC) scores do not increase cardiac event risk in patients with nonischemic myocardial perfusion scintigraphy (MPS) results. A normal MPS test indicates no need for aggressive intervention, even with high CAC scores.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Cardiology
Background:
- Myocardial perfusion scintigraphy (MPS) is established for cardiac prognosis.
- Coronary artery calcium (CAC) scoring also predicts cardiac outcomes.
- Limited data exist on combined CAC and MPS prognostic value.
Purpose of the Study:
- To evaluate prognosis in patients who underwent both CAC scanning and MPS.
- To compare outcomes between patients with dual testing versus MPS alone.
Main Methods:
- Assessed cardiac death and myocardial infarction in 1,153 patients with CAC and MPS.
- Compared outcomes with a referent cohort of 9,308 patients who had MPS only.
- Mean follow-up was 32 months.
Main Results:
- Ischemia frequency increased with CAC scores (p < 0.001).
- Among 1,089 nonischemic patients, cardiac event rates were <1% across all CAC subgroups, including scores >1,000.
- Low cardiac event rates and similar revascularization rates were observed for nonischemic patients with high CAC scores versus high Bayesian likelihood.
Conclusions:
- High CAC scores do not increase cardiac event risk in patients with nonischemic MPS.
- A normal MPS study suggests no need for aggressive intervention, regardless of CAC score.
- Intensive medical therapy may be considered for high CAC scores to prevent future events.
Objectives:
The purpose of this work was to assess the prognosis in patients undergoing both coronary artery calcium (CAC) scanning and exercise myocardial perfusion scintigraphy (MPS).
Background:
Whereas the prognostic effectiveness of MPS is well established, recent studies indicate that quantification of CAC also predicts cardiac outcomes. However, prognostic information is not yet available upon which to guide the management of patients who have had both tests.
Methods:
We assessed the frequency of cardiac death and myocardial infarction over a mean follow-up of 32 +/- 16 months in 1,153 patients undergoing both CAC scanning and MPS. Results were compared with those from a referent cohort of 9,308 patients who had earlier undergone MPS only.
Results:
The frequency of myocardial ischemia rose with increasing CAC scores (p < 0.001), but ischemia was present in only 64 patients. Among the 1,089 nonischemic patients, of which only 3 (0.3%) underwent early revascularization, the annualized cardiac event rate was <1% in all CAC subgroups, including those with CAC scores >1,000. Kaplan-Meier analysis revealed similarly low cardiac event rates among nonischemic patients with CAC scores >1,000 and nonischemic patients with Bayesian coronary artery disease likelihood > or =85%. Late myocardial revascularization rates were also similar in these 2 groups.
Conclusions:
Among patients with nonischemic MPS studies, high CAC scores do not confer an increased risk for cardiac events. Thus, although patients with high CAC scores may be considered for intensive medical therapy to prevent future coronary artery disease events, a normal MPS study in such patients suggests no need for more aggressive interventions.
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