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Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
Changes in cardiovascular medication after coronary artery calcium scanning and normal single photon emission
Elsemiek M Engbers1, Jorik R Timmer2, Mohamed Mouden1
1Department of Cardiology, Isala, Zwolle, the Netherlands; Department of Nuclear Medicine, Isala, Zwolle, the Netherlands.
Insights
Coronary artery calcium (CAC) scoring influences cardiovascular medication use in patients with normal myocardial perfusion imaging (MPI). Higher CAC scores correlate with increased aspirin and statin initiation, while lower scores may lead to discontinuation.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary artery calcium (CAC) scoring is increasingly used in cardiovascular risk assessment.
- Its impact on medication management in patients with normal myocardial perfusion imaging (MPI) requires further elucidation.
- Symptomatic patients with normal MPI findings often undergo CAC scoring to refine risk stratification.
Purpose of the Study:
- To investigate the association between CAC scores and subsequent changes in aspirin and statin use.
- To evaluate medication initiation and discontinuation patterns based on CAC score categories.
- To determine if CAC scoring influences therapeutic decisions in patients suspected of coronary artery disease.
Main Methods:
- Retrospective analysis of 1,033 stable symptomatic patients with normal single-photon emission computed tomography (SPECT) MPI and concomitant CAC scoring.
- Patients were categorized into four groups based on CAC score: 0, 1-99, 100-399, and ≥400.
- Medication changes (initiation or discontinuation of aspirin and statin) were assessed at subsequent outpatient visits.
Main Results:
- Higher CAC scores were significantly associated with increased initiation of both aspirin and statin therapy.
- Patients with lower CAC scores (especially CAC=0) were more likely to discontinue aspirin and statin.
- After adjusting for risk factors, elevated CAC scores independently predicted higher rates of posttest aspirin and statin use.
Conclusions:
- CAC scoring provides valuable information for guiding cardiovascular medication use in patients with normal SPECT MPI.
- Higher CAC scores are linked to increased initiation of cardioprotective medications.
- Lower CAC scores are associated with a greater likelihood of medication discontinuation.
Abstract:
The impact of coronary artery calcium (CAC) scoring on subsequent changes in cardiovascular medication use in symptomatic patients with normal myocardial perfusion imaging (MPI) findings is not well established. The aim of the current study was to evaluate changes in aspirin and statin use in patients suspected for coronary artery disease after CAC scoring and normal single photon emission computed tomography (SPECT) MPI.
Methods:
In the current study, 1,033 stable symptomatic patients without a known history of coronary artery disease with normal SPECT MPI who underwent concomitant CAC scoring were included. All patients had a clinical indication for imaging, mainly atypical chest pain and dyspnea, and were referred from the outpatient clinic of our hospital. Data regarding posttest medication change (either starting or discontinuation of aspirin and statin therapy at the subsequent outpatient visit) were retrospectively collected. Patients were categorized into 4 groups based on their CAC score.
Results:
Mean age of the patients was 61±11 years and 39% were male. At baseline, 35% of the patients used aspirin and 39% used statin. In patients with CAC scores 0, 1-99, 100-399, and ≥400, aspirin was started in 1%, 4%, 9%, and 9%, respectively, and statin was started in 0%, 7%, 18%, and 24% of the patients, respectively (P<.001). Aspirin was discontinued in 19%, 11%, 7%, and 1% and statin was discontinued in 8%, 6%, 2%, and 0% (P<.001) of the patients in these respective CAC score categories. After correction for differences in risk factors and baseline medication use, increased CAC was independently associated with posttest aspirin (odds ratio 4.6, 11.2, and 27.1 for CAC scores 1-99, 100-399, and ≥400, respectively; P<.001) and statin use (odds ratio 4.4, 19.4, and 60.9 for CAC scores 1-99, 100-399, and ≥400, respectively; P<.001).
Conclusions:
Higher CAC scores are associated with the initiation of aspirin and statin therapy in patients with normal SPECT MPI. In patients with lower CAC scores, discontinuation of cardioprotective medication is more likely. CAC score is independently associated with posttest statin and aspirin use.
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