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
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Figure 1 Cardiac Events According to CAC Scores
Survival curves for freedom from cardiac death or nonfatal myocardial infarction (MI) (y-axis) among the coronary artery calcium (CAC) patients who had nonischemic exercise myocardial perfusion scintigraphy studies. (Left) Kaplan-Meier survival curve analysis as a function of CAC scores before adjustment for covariates of outcome. The p value is derived using the log-rank test. (Right) Cox proportional hazards model for freedom from cardiac death or MI risk adjusted for age, dyspnea, and coronary risk factors. The p value is that of CAC in the Cox risk-adjusted model. Patients with early myocardial revascularization were censored from the analysis. DM = diabetes mellitus; SOB = shortness of breath.
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Figure 2 Cardiac Events According to ASCAD LL
Survival curves for freedom from cardiac death or nonfatal myocardial infarction (MI) among the myocardial perfusion scintigraphy (MPS) referral subgroup who had nonischemic exercise MPS studies. (Left) Kaplan-Meier survival curve analysis as a function of the likelihood (LL) of angiographically significant coronary artery disease (CAD). (Right) Cox risk-adjusted model for freedom of cardiac death or MI risk adjusted for age, dyspnea, and coronary risk factors. Other abbreviations as in Figure 1.
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Figure 3 Comparison of Outcomes Among Patient Groups
(Left) Kaplan-Meier survival curves for freedom from cardiac death or myocardial infarction in the propensity-matched coronary artery calcium (CAC) and myocardial perfusion scintigraphy (MPS) cohorts who had no ischemia during stress MPS testing. (Right) Kaplan-Meier survival curves for the propensity-matched MPS patients with coronary artery disease likelihood (LL) values <15%, 15% to 85%, and  85% and for the patients with CAC scores 1,000. There were no statistical differences among the subgroups.
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Figure 4 Comparison of Rates for Late Revascularization
(Left) Kaplan-Meier curves for freedom from late myocardial revascularization among the coronary artery calcium (CAC) patients having nonischemic myocardial perfusion scintigraphy (MPS). (Right) Kaplan-Meier curves for freedom from late myocardial revascularization among the nonischemic MPS patients. CAD = coronary artery disease; LL = low likelihood.
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