The Coronary Artery Calcium Score and Stress Myocardial Perfusion Imaging Provide Independent and Complementary Prediction of Cardiac Risk

OBJECTIVES: This study sought to examine the relationship between coronary artery calcium score (CACS) and single-photon emission computed tomography (SPECT) results for predicting the short- and long-term risk of cardiac events. Background: The CACS and SPECT results both provide important prognostic information. It is unclear whether integrating these tests will better predict patient outcome.

METHODS: We followed-up 1,126 generally asymptomatic subjects without previous cardiovascular disease who had a CACS and stress SPECT scan performed within a close time period (median 56 days). The median follow-up was 6.9 years. End points analyzed were total cardiac events and all-cause death/myocardial infarction (MI).

RESULTS: An abnormal SPECT result increased with increasing CACS from <1% (CACS≤10) to 29% (CACS >400) (p < 0.001). Total cardiac events and death/MI also increased with increasing CACS and abnormal SPECT results (p < 0.001). In subjects with a normal SPECT result, CACS added incremental prognostic information, with a 3.55-fold relative increase for any cardiac event (2.75-fold for death/MI) when the CACS was severe (>400) versus minimal (≤10). Separation of the survival curves occurred at 3 years after initial testing for all cardiac events and at 5 years for death/MI.

CONCLUSIONS: The CACS and SPECT findings are independent and complementary predictors of short- and long-term cardiac events. Despite a normal SPECT result, a severe CACS identifies subjects at high long-term cardiac risk. After a normal SPECT result, our findings support performing a CACS in patients who are at intermediate or high clinical risk for coronary artery disease to better define those who will have a high long-term risk for adverse cardiac events. 


Posted in Computed Tomography, Nuclear Imaging and tagged , , .

One Comment

  1. Cheng et al report that “although a normal SPECT result predicts excellent short-term event-free survival, long-term outcome is significantly worse if the CACS is severe.”

    In their study, they showed that CAC scoring and SPECT results provide independent and complementary predictors of a patient’s cardiovascular disease risk. While a normal SPECT result predicts short-term event-free survival, the presence of a significantly elevated CAC score is associated with greater long-term risk for cardiac adverse events.

    Related study:
    Stable coronary artery disease: prognostic value of myocardial perfusion SPECT in relation to coronary calcium scoring-long-term follow-up.
    Uebleis C, Becker A, Griesshammer I, Cumming P, Becker C, Schmidt M, Bartenstein P, Hacker M.
    Radiology. 2009 Sep;252(3):682-90.

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