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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
High coronary artery calcium score affects clinical outcome despite normal stress myocardial perfusion imaging and
Claus Madsen1, Kim F Andersen, Bo Zerahn
1Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark. cljuma01@heh.regionh.dk
Insights
High coronary artery calcium score (CACS) significantly predicts cardiac events and death in patients with normal myocardial perfusion imaging (MPI). CACS is crucial for identifying at-risk individuals, even with seemingly normal heart function.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Normal myocardial perfusion imaging (MPI) typically suggests a low risk for cardiac events.
- The prognostic value of a normal MPI in conjunction with a high coronary artery calcium score (CACS) remains unclear.
- This study investigates the risks associated with elevated CACS in patients with normal MPI.
Purpose of the Study:
- To evaluate the risk of severely elevated CACS in patients with normal MPI.
- To identify other risk factors for adverse cardiac events in this population.
Main Methods:
- 318 patients underwent Tc-sestamibi MPI and CACS acquisition.
- Stress testing included ergometer bicycle or pharmacological methods.
- Median follow-up was 989 days, with endpoints including myocardial infarction, revascularization, and death.
Main Results:
- 62 patients (19%) had a CACS of at least 400.
- Elevated CACS (≥400) predicted cardiovascular events or death (RR 3.4, P=0.008).
- Inability to perform stress testing and diabetes were also significant predictors of cardiac events.
Conclusions:
- Coronary artery calcium score (CACS) is the primary predictor of cardiac events and/or death in patients with normal MPI.
- Incorporating CACS assessment with MPI can enhance risk stratification for cardiac events.
- This approach aids in identifying patients who may benefit from closer cardiac monitoring or intervention.
Background:
Normal myocardial perfusion imaging (MPI) indicates a low risk for cardiac death and new ischaemic events. However, the impact of normal MPI combined with a high coronary artery calcium score (CACS) is not clear. The aims of this study were to evaluate the risk of severely elevated CACS and to identify other risk factors in patients with normal MPI.
Methods:
The study included 318 consecutive patients who underwent a Tc-sestamibi MPI protocol along with either the ergometer bicycle test or the pharmacological stress test. Acquisition of CACS was performed immediately before MPI. Patient history and events were retrieved from hospital files. The median follow-up time was 989 days. End points were myocardial infarction, need for revascularization of coronary arteries and/or death.
Results:
CACS was less than 400 in 256 patients (81%) and at least 400 in 62 patients with normal MPI. Cox regression analysis showed that CACS was a predictor of cardiovascular events or death [relative risk (RR) 3.4, P=0.008]. Inability to perform the ergometer stress test (RR 5.6, P=0.02) was also included in the model. CACS (RR 4.2, P=0.01) and diabetes (RR 3.7, P=0.03) were the strongest predictors of cardiac events without death.
Conclusion:
CACS is the single most important predictor of cardiac events and/or death in patients with normal MPI. If possible, CACS could be included when performing MPI to identify patients with an increased risk for cardiac events and/or death.
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