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. 2024 Mar 27;25(4):482-490.
doi: 10.1093/ehjci/jead288.

Impact of myocardial perfusion and coronary calcium on medical management for coronary artery disease

Waseem Hijazi  1 , Yuanchao Feng  1 , Danielle A Southern  2   3   4   5 , Derek Chew  1   2   3   4   5 , Neil Filipchuk  1 , Bryan Har  1 , Matthew James  2   3   4   5 , Stephen Wilton  1 , Piotr J Slomka  6   7   8 , Daniel Berman  6   7   8 , Robert J H Miller  1
Affiliations

Impact of myocardial perfusion and coronary calcium on medical management for coronary artery disease

Waseem Hijazi et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) remains one of the most widely used imaging modalities for the diagnosis and prognostication of coronary artery disease (CAD). Despite the extensive prognostic information provided by MPI, little is known about how this influences the prescription of medical therapy for CAD. We evaluated the relationship between MPI with computed tomography (CT) attenuation correction and prescription of acetylsalicylic acid (ASA) and statins.

Methods and results: We performed a retrospective analysis of consecutive patients who underwent SPECT MPI at a single centre between 2015 and 2021. Myocardial perfusion abnormalities and coronary calcium burden were assessed, with attenuation correction imaging 77.8% of patients. Medication prescriptions before and within 180 days after the test were compared. Associations between abnormal perfusion and calcium burden with ASA and statin prescription were assessed using multivariable logistic regression. In total, 9908 patients were included, with a mean age 66.8 ± 11.7 years and 5337 (53.9%) males. The prescription of statins increased more in patients with abnormal perfusion (increase of 19.2 vs. 12.0%, P < 0.001). Similarly, the presence of extensive CAC led to a greater increase in statin prescription compared with no calcium (increase 12.1 vs. 7.8%, P < 0.001). In multivariable analyses, ischaemia and coronary artery calcium were independently associated with ASA and statin prescription.

Conclusion: Abnormal MPI testing was associated with significant changes in medical therapy. Both calcium burden and perfusion abnormalities were associated with increased prescriptions of medical therapy for CAD.

Keywords: coronary artery disease; medical therapy; myocardial perfusion imaging.

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Conflict of interest statement

Conflict of interest: R.J.H.M. received consulting fees and research support from Pfizer. D.B. and P.J.S. participate in software royalties for QPS software at Cedars-Sinai Medical Center. P.J.S. has received research grant support from Siemens Medical Systems.

Figures

Graphical Abstract
Graphical Abstract
Overview of study design. Perfusion and coronary artery calcium (CAC) were assessed for patients undergoing myocardial perfusion imaging (MPI). We evaluated associations between imaging findings and prescriptions of medical therapy including acetylsalicylic acid and statins.
Figure 1
Figure 1
Prescriptions before and after myocardial perfusion imaging, stratified by perfusion findings. Baseline medical therapy was used more frequently in patients with abnormal perfusion but also increased to a greater extent after study for all medication classes.
Figure 2
Figure 2
Medication prescriptions after myocardial perfusion imaging stratified by visually estimated coronary artery calcium (CAC).
Figure 3
Figure 3
Medication prescriptions after myocardial perfusion imaging stratified by visually estimated coronary artery calcium (CAC) and presence of ischaemia. CAC was assessed on computed tomography attenuation correction (CTAC) imaging.
See this image and copyright information in PMC

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