EXPEDITED REVIEW
Clinical Outcomes After Both Coronary Calcium Scanning and Exercise Myocardial Perfusion Scintigraphy
Alan Rozanski, MD, FACC*,
Heidi Gransar, MS ,
Nathan D. Wong, PhD, FACC ,
Leslee J. Shaw, PhD,
Romalisa Miranda-Peats, MPH,
Donna Polk, MD,
Sean W. Hayes, MD,
John D. Friedman, MD, MPH, FACC and
Daniel S. Berman, MD, FACC,*
* Department of Medicine, St. Luke’s Roosevelt Hospital, New York, New York
Departments of Imaging and Medicine and the Burns and Allen Research Institute, Cedars-Sinai Medical Center, and the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
Heart Disease Prevention Program, University of California, Irvine, California.
Manuscript received August 22, 2006;
revised manuscript received November 22, 2006,
accepted December 8, 2006.
* Reprint requests and correspondence: Dr. Daniel S. Berman, Director of Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 1258, Los Angeles, California 90048. (Email: bermand{at}cshs.org).
Objectives: The purpose of this work was to assess the prognosis in patients undergoing both coronary artery calcium (CAC) scanning and exercise myocardial perfusion scintigraphy (MPS).
Background: Whereas the prognostic effectiveness of MPS is well established, recent studies indicate that quantification of CAC also predicts cardiac outcomes. However, prognostic information is not yet available upon which to guide the management of patients who have had both tests.
Methods: We assessed the frequency of cardiac death and myocardial infarction over a mean follow-up of 32 ± 16 months in 1,153 patients undergoing both CAC scanning and MPS. Results were compared with those from a referent cohort of 9,308 patients who had earlier undergone MPS only.
Results: The frequency of myocardial ischemia rose with increasing CAC scores (p < 0.001), but ischemia was present in only 64 patients. Among the 1,089 nonischemic patients, of which only 3 (0.3%) underwent early revascularization, the annualized cardiac event rate was <1% in all CAC subgroups, including those with CAC scores >1,000. Kaplan-Meier analysis revealed similarly low cardiac event rates among nonischemic patients with CAC scores >1,000 and nonischemic patients with Bayesian coronary artery disease likelihood  85%. Late myocardial revascularization rates were also similar in these 2 groups.
Conclusions: Among patients with nonischemic MPS studies, high CAC scores do not confer an increased risk for cardiac events. Thus, although patients with high CAC scores may be considered for intensive medical therapy to prevent future coronary artery disease events, a normal MPS study in such patients suggests no need for more aggressive interventions.
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Abbreviations and Acronyms
| | ASCAD = angiographically significant coronary artery disease | | CAC = coronary artery calcium | | CAD = coronary artery disease | | CSMC = Cedars-Sinai Medical Center | | EBT = electron beam computed tomography | | MPS = myocardial perfusion scintigraphy | | MSCT = multislice computed tomography |
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