Abstract:
Background: Estimation of coronary artery calcification (CAC) can provide important prognostic information in patients with suspected coronary artery disease.
Objectives: We aimed to investigate whether CAC evaluation offers additional insight into the association of stress ECG changes with adverse outcomes in patients undergoing myocardial perfusion imaging (MPI).
Methods: 12,265 patients (47% female, age: 64±12 years, body mass index: 29±7 kg/m2) who underwent exercise treadmill or regadenoson SPECT/CT MPI during 06/2016-05/2022 at a large academic center were retrospectively studied.
Results: During the median follow-up of 1.6 (interquartile range: 0.5-3.0) years, the primary outcome (3-year composite of death, myocardial infarction, or coronary revascularization, MACE) occurred in 1,422 patients. Within participants with normal perfusion, MACE rate was the highest in patients with CAC with or without ischemic stress ECG (9.6% and 7% respectively) and low event rates were observed in patients without CAC with or without ischemic stress ECG (0.5% and 1.9% respectively). In a subgroup analysis, all CAC grades (mild, moderate, severe) were independently associated with worse 3-year composite endpoint rates. In multivariable analysis, the presence of CAC was associated with MACE independent of ischemic ECG changes in both the overall cohort (p<0.001) and when restricting the analysis to patients with normal perfusion (p<0.05).
Conclusions: In patients with normal SPECT/CT MPI, CAC is strongly associated with adverse outcomes independent of ischemic ECG changes with low event rates in patients without CAC on attenuation CT irrespective of ischemic stress ECG changes.
JACC: Advances Editor-in-Chief
Candice K. Silversides, MD, FACC
JACC: Advances CME Editor
Kenneth A. Ellenbogen, MD
Author
Valerian Fernandes, MBBS FACC
Important Dates
Date of Release: March 26, 2025
Term of Approval/Date of CME/MOC Expiration: March 25, 2026