Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2008 Apr 1;117(13):1693-700.
doi: 10.1161/CIRCULATIONAHA.107.717512. Epub 2008 Mar 24.

Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography/computed tomography study

Matthew P Schenker  1 , Sharmila Dorbala, Eric Cho Tek Hong, Frank J Rybicki, Rory Hachamovitch, Raymond Y Kwong, Marcelo F Di Carli
Affiliations
Comparative Study

Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography/computed tomography study

Matthew P Schenker et al. Circulation. .

Abstract

Background: Although the value of coronary artery calcium (CAC) for atherosclerosis screening is gaining acceptance, its efficacy in predicting flow-limiting coronary artery disease remains controversial, and its incremental prognostic value over myocardial perfusion is not well established.

Methods and results: We evaluated 695 consecutive intermediate-risk patients undergoing combined rest-stress rubidium 82 positron emission tomography (PET) perfusion imaging and CAC scoring on a hybrid PET-computed tomography (CT) scanner. The frequency of abnormal scans among patients with a CAC score > or = 400 was higher than that in patients with a CAC score of 1 to 399 (48.5% versus 21.7%, P<0.001). Multivariate logistic regression supported the concept of a threshold CAC score > or = 400 governing this relationship (odds ratio 2.91, P<0.001); however, the frequency of ischemia among patients with no CAC was 16.0%, and its absence only afforded a negative predictive value of 84.0%. Risk-adjusted survival analysis demonstrated a stepwise increase in event rates (death and myocardial infarction) with increasing CAC scores in patients with and without ischemia on PET myocardial perfusion imaging. Among patients with normal PET myocardial perfusion imaging, the annualized event rate in patients with no CAC was lower than in those with a CAC score > or = 1000 (2.6% versus 12.3%, respectively). Likewise, in patients with ischemia on PET myocardial perfusion imaging, the annualized event rate in those with no CAC was lower than among patients with a CAC score > or = 1000 (8.2% versus 22.1%).

Conclusions: Although increasing CAC content is generally predictive of a higher likelihood of ischemia, its absence does not completely eliminate the possibility of flow-limiting coronary artery disease. Importantly, a stepwise increase occurs in the risk of adverse events with increasing CAC scores in patients with and without ischemia on PET myocardial perfusion imaging.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Bar graph illustrating the frequency of ischemic PET MPI by CAC score.
Figure 2
Figure 2
Bar graph illustrating the frequency of ischemic PET MPI by CAC score and CAC percentile (%ile) ranking. Within each of the 3 percentile groups, patients are subdivided by their absolute calcium score.
Figure 3
Figure 3
Receiver operating characteristic curve analysis illustrating the incremental value of CAC score for predicting ischemic PET MPI.
Figure 4
Figure 4
Cox proportional hazards regression model for freedom from death or MI adjusted for age, sex, symptoms, and conventional CAD risk factors (median follow-up 553 days).
Figure 5
Figure 5
Cox proportional hazards regression model for freedom from death or MI adjusted for age, sex, symptoms, and conventional CAD risk factors in patients without ischemia (top) and with ischemia (bottom).
See this image and copyright information in PMC

Comment in

References

    1. Anderson KM, Castelli WP, Levy D. Cholesterol and mortality: 30 years of follow-up from the Framingham study. JAMA. 1987;257:2176–2180. - PubMed
    1. Braunwald E. Shattuck lecture: cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med. 1997;337:1360–1369. - PubMed
    1. Heller RF, Chinn S, Pedoe HD, Rose G. How well can we predict coronary heart disease? Findings in the United Kingdom Heart Disease Prevention Project. BMJ. 1984;288:1409–1411. - PMC - PubMed
    1. Wald NJ, Law M, Watt HC, Wu T, Bailey A, Johnson AM, Craig WY, Ledue TB, Haddow JE. Apolipoproteins and ischaemic heart disease: implications for screening. Lancet. 1994;343:75–79. - PubMed
    1. Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD. Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol. 2000;36:1253–1260. - PubMed

Publication types