Elsevier

Journal of Nuclear Cardiology

Volume 12, Issue 4, July–August 2005, Pages 392-400
Journal of Nuclear Cardiology

Original article
Clinical utility of coronary calcium scoring after nonischemic myocardial perfusion imaging

https://doi.org/10.1016/j.nuclcard.2005.04.006Get rights and content

Background

Coronary artery calcium (CAC) scoring is increasingly being used after myocardial perfusion imaging (MPI) to detect preclinical coronary artery disease (CAD). However, there are few data to support this approach.

Methods and Results

We reviewed 200 consecutive patients without known CAD who were referred for CAC scoring shortly after nonischemic MPI. Of these, 13 (6.5%) had CAC scores greater than 400, indicating significant CAD; 22 (11%) had CAC scores of 101 to 400; 27 had CAC scores of 11 to 100; and the remainder (n = 138) has CAC scores of 1 to 10. Traditional risk factors and patient characteristics were not significant predictors of CAC scores of 101 or greater. However, age and the Framingham risk score were predictors of CAC scores greater than 0. At follow-up, significantly more patients with CAC scores of 101 or greater had been given the advice to take lipid-lowering medication and aspirin compared with those with CAC scores of 0.

Conclusions

Of patients referred for CAC scoring after nonischemic MPI, 17.5% were identified as having CAD based on a CAC score greater than 100, allowing intervention with aggressive medical therapy. Patients who were reclassified were not easily identifiable by traditional risk factors, but Framingham risk score did predict the presence of CAC. Clinicians modified medical therapy based on the results of CAC scoring.

Section snippets

Methods

The study population included patients without known CAD who had undergone diagnostic MPI and were then referred by their physician for CAC screening by MDCT in close temporal proximity. All patients were seen at Cardiovascular Consultants and the Mid America Heart Institute, Kansas City, Mo, and were identified by a retrospective review of the databases at our center. Subsequent follow-up was obtained by review of medical records.

Results

Of the 200 patients in the study, 73 (36.5%) were men; the mean age was 54.7 ± 13 years; and 96% had 2 or more cardiac risk factors. Important clinical and stress test characteristics of the study population are listed in Table 1. The coronary calcium score was normal (Agatston score = 0) in 108 patients, minimally abnormal (>0–10) in 27, mildly abnormal (>10–100) in 30, significantly abnormal (>101–400) in 22, and severely abnormal (>400) in 13 (Figure 1).

Table 2 shows the comparison of

Discussion

This is first study to specifically examine the clinical utility of CAC scoring after MPI. We found that in patients who had a normal MPI study who were referred by their physician for coronary calcium scanning, 17.5% were reclassified as having significant CAD based on a CAC score greater than 100. Physicians seemed to incorporate the additional coronary calcium score data in the management of these patients. Of patients who had a normal MPI study and a CAC score greater than 100 (and were

Acknowledgment

The authors have indicated they have no financial conflicts of interest.

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