The Coronary Artery Calcium Score and Stress Myocardial Perfusion Imaging Provide Independent and Complementary Prediction of Cardiac Risk
Su Min Chang, MD,
Faisal Nabi, MD,
Jiaqiong Xu, PhD,
Leif E. Peterson, PhD,
Arup Achari, MD,
Craig M. Pratt, MD and
John J. Mahmarian, MD*
Methodist DeBakey Heart and Vascular Center and The Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas
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Figure 1 Relation Between CACS and SPECT Results
Relation between coronary artery calcium score (CACS) severity and stress single-photon emission computed tomography (SPECT) results in 717 subjects who underwent both tests within 6 months. The percentage of subjects with an abnormal SPECT result (p < 0.001) and those with a large stress-induced total ( 15%) and ischemic (10%) left ventricular (LV) perfusion defect size (PDS) (p < 0.001) significantly increased with increasing CACS severity.
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Figure 2 Event Rates Based on CACS Severity
Total cardiac death, myocardial infarction (MI), and coronary revascularization (A) and all-cause death/MI (B) event rates based on CACS severity. Abbreviations as in Figure 1.
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Figure 3 Event Rates Based on SPECT Results: Total Perfusion Defect Size
Total cardiac death, MI, and coronary revascularization (A) and all-cause death/MI (B) event rates based on stress SPECT results of normal, abnormal with an LV PDS <15%, and abnormal with an LV PDS 15%. Abbreviations as in Figures 1 and 2.
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Figure 4 Event Rates Based on SPECT Results: Ischemic Perfusion Defect Size
Total cardiac death, MI, and coronary revascularization (A) and all-cause death/MI (B) event rates based on stress SPECT results of normal, abnormal with a <10% ischemic PDS, and abnormal with a 10% ischemic PDS. Abbreviations as in Figures 1 and 2.
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Figure 5 Adjusted Annualized Event Rates Based on CACS and SPECT Results
Adjusted annualized total cardiac death, MI, and coronary revascularization (A) and all-cause death/MI (B) event rates based on CACS and SPECT results. Abbreviations as in Figures 1 and 2.
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Figure 6 Event Rates in Subjects With a Normal SPECT Result Based on CACS Severity
Total cardiac death, MI, and coronary revascularization (A) and all-cause death/MI (B) event rates based on CACS severity in subjects with a normal stress SPECT result. Abbreviations as in Figures 1 and 2.
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Figure 7 Incremental Prognostic Value of Clinical, SPECT, and CACS Results
Incremental predictive value of CACS and stress SPECT results over clinical information by global chi-square analysis. (A and B) Total PDS was used as the SPECT variable. (C and D) Ischemic perfusion defect size (IPDS) was used as the SPECT variable. Clinical model: age, sex, diabetes, hypertension, hyperlipidemia, smoking history, family history of coronary artery disease, chest pain, abnormal resting electrocardiogram, and inability to exercise. Abbreviations as in Figures 1 and 2.
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