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Research ArticleClinical Investigations

Coronary Calcium Score as an Adjunct to Nuclear Myocardial Perfusion Imaging for Risk Stratification Before Noncardiac Surgery

Jelena R. Ghadri, Michael Fiechter, Katja Veraguth, Catherine Gebhard, Aju P. Pazhenkottil, Tobias A. Fuchs, Christian Templin, Oliver Gaemperli and Philipp A. Kaufmann
Journal of Nuclear Medicine July 2012, 53 (7) 1081-1086; DOI: https://doi.org/10.2967/jnumed.111.100206
Jelena R. Ghadri
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Michael Fiechter
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Katja Veraguth
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Catherine Gebhard
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Aju P. Pazhenkottil
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Tobias A. Fuchs
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Christian Templin
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Oliver Gaemperli
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Philipp A. Kaufmann
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  • FIGURE 1.
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    FIGURE 1.

    Bar graph showing prevalence of normal or abnormal SPECT MPI findings across subgroups of CACS. y-axis denotes percentage of patients taken from entire study population of 326 patients.

  • FIGURE 2.
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    FIGURE 2.

    Kaplan–Meier survival curves for cumulative survival free of MACE according to subgroups of normal or abnormal SPECT MPI findings and CACS above or below 1,314 (P < 0.05, log-rank test).

  • FIGURE 3.
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    FIGURE 3.

    Cumulative MACE rate for patients with normal or abnormal SPECT MPI findings and CACS above or below cutoff value of 1,314 (P < 0.05, log-rank test).

Tables

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    TABLE 1

    Baseline Characteristics (n = 326)

    CharacteristicValue
    Mean age ± SD (y)71.1 ± 8.5
    Sex (n)
     Male247 (76)
     Female79 (24)
    Mean body mass index ± SD (kg/m2)26 ± 6
    Cardiovascular risk factors (n)
     Arterial hypertension235 (72)
     Dyslipidaemia218 (67)
     Current or former smoker219 (67)
     Diabetes mellitus68 (21)
     Positive family history31 (10)
    Cardiovascular history (n)
     Known CAD132 (41)
     Revascularization97 (30)
     Myocardial infarction62 (19)
     Stroke or transient ischemic attack39 (12)
     Congestive heart failure26 (8)
    Medication (n)
     Aspirin201 (62)
     Angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker181 (56)
     β-blocker167 (51)
     Statin178 (55)
     Nitroglycerin14 (4)
    • Data in parentheses are percentages.

    • View popup
    TABLE 2

    Cumulative MACE Rate

    ParameterNo. of MACE patients (of 30 total)P
    Separate predictive values of SPECT MPI and CACS
     SPECT MPI0.005
      Normal findings (n = 242)16 (7)
      Abnormal findings (n = 84)14 (17)
     CACS0.005
     <1,314 (n = 216)13 (6)
     ≥1,314 (n = 110)17 (16)
    Added value of CACS combined with SPECT MPI
     Normal SPECT MPI findings0.003
      <1,314 (n = 173)8 (5)
      ≥1,314 (n = 69)8 (12)
     Abnormal SPECT MPI findings0.002
      <1,314 (n = 43)5 (12)
      ≥1,314 (n = 41)9 (22)
    • P values indicate results from log-rank test. Data in parentheses are percentages.

    • View popup
    TABLE 3

    Predictor of MACE on Cox Proportional Hazards Regression Models

    UnivariateMultivariate
    CharacteristicHR95% CIPHR95% CIP
    Age1.030.99–1.070.141NANS
    Sex0.790.32–1.9290.58NANS
    Surgical risk estimate1.320.73–2.370.34NANS
    Lee index1.731.20–2.460.0031.551.06–2.260.022
    SPECT MPI2.611.28–5.360.009NANS
    CACS log2.101.15–3.830.015NANS
    CACS ≥ 1,3142.721.32–5.600.0072.21.04–4.670.038
    • NA = not applicable; NS = not significant.

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Journal of Nuclear Medicine: 53 (7)
Journal of Nuclear Medicine
Vol. 53, Issue 7
July 1, 2012
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Coronary Calcium Score as an Adjunct to Nuclear Myocardial Perfusion Imaging for Risk Stratification Before Noncardiac Surgery
Jelena R. Ghadri, Michael Fiechter, Katja Veraguth, Catherine Gebhard, Aju P. Pazhenkottil, Tobias A. Fuchs, Christian Templin, Oliver Gaemperli, Philipp A. Kaufmann
Journal of Nuclear Medicine Jul 2012, 53 (7) 1081-1086; DOI: 10.2967/jnumed.111.100206

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Coronary Calcium Score as an Adjunct to Nuclear Myocardial Perfusion Imaging for Risk Stratification Before Noncardiac Surgery
Jelena R. Ghadri, Michael Fiechter, Katja Veraguth, Catherine Gebhard, Aju P. Pazhenkottil, Tobias A. Fuchs, Christian Templin, Oliver Gaemperli, Philipp A. Kaufmann
Journal of Nuclear Medicine Jul 2012, 53 (7) 1081-1086; DOI: 10.2967/jnumed.111.100206
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