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J Am Coll Cardiol, 2004; 44:923-930, doi:10.1016/j.jacc.2004.06.042 © 2004 by the American College of Cardiology Foundation |
,*
* Departments of Imaging and Medicine and the Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
Heart Disease Prevention Program, University of California, Irvine, California, USA
Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Manuscript received January 15, 2004; revised manuscript received June 14, 2004, accepted June 15, 2004.
* Reprint requests and correspondence: Dr. Daniel S. Berman, Director of Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Building, Room 1258, Los Angeles, California 90048 (Email: bermand{at}cshs.org).
OBJECTIVES: We assessed the relationship between stress-induced myocardial ischemia on myocardial perfusion single-photon emission computed tomography (MPS) and magnitude of coronary artery calcification (CAC) by X-ray tomography in patients undergoing both tests.
BACKGROUND: There has been little evaluation regarding the relationship between CAC and inducible ischemia or parameters that might modify this relationship.
METHODS: A total of 1,195 patients without known coronary disease, 51% asymptomatic, underwent stress MPS and CAC tomography within 7.2 ± 44.8 days. The frequency of ischemia by MPS was compared to the magnitude of CAC abnormality.
RESULTS: Among 76 patients with ischemic MPS, the CAC scores were >0 in 95%, 
100 in 88%, and 400 in 68%. Of 1,119 normal MPS patients, CAC scores were >0, 100, and 400 in 78%, 56%, and 31%, respectively. The frequency of ischemic MPS was <2% with CAC scores <100 and increased progressively with CAC 100 (p for trend <0.0001). Patients with symptoms with CAC scores 400 had increased likelihood of MPS ischemia versus those without symptoms (p = 0.025). Absolute rather than percentile CAC score was the most potent predictor of MPS ischemia by multivariable analysis. Importantly, 56% of patients with normal MPS had CAC scores 100.
CONCLUSIONS: Ischemic MPS is associated with a high likelihood of subclinical atherosclerosis by CAC, but is rarely seen for CAC scores <100. In most patients, low CAC scores appear to obviate the need for subsequent noninvasive testing. Normal MPS patients, however, frequently have extensive atherosclerosis by CAC criteria. These findings imply a potential role for applying CAC screening after MPS among patients manifesting normal MPS.
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