Image For Activity Cover
Significance of Coronary Artery Calcifications and Ischemic Electrocardiographic Changes Among Patients Undergoing Myocardial Perfusion Imaging (JACC: Advances March 2025)
Description

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 

Summary
Availability: On-Demand
Access expires on Mar 25, 2026
Cost: FREE
Credit Offered:
1 CME Credit
1 ABIM-MOC Point
Android App Download IOS App Download Powered By