title: Absent coronary artery calcium excludes inducible myocardial ischemia on computed tomography/positron emission tomography.
abstract: OBJECTIVE
  We set out to determine whether a coronary artery calcium (CAC) score of zero on computed tomography (CT) would predict a normal myocardial perfusion positron emission tomography (PET) in a population mostly at intermediate pretest likelihood of coronary artery disease (CAD).
  
  
  METHODS
  We enrolled 206 outpatients (36% men, mean age 60 ± 13 years) referred for Rb-82 myocardial perfusion PET/CT for suspected CAD. CAC scoring was performed by the Agatston method. The PET images were scored on a 5-point scale using a 17-segment left ventricular model. A summed stress score ≥ 2 was considered abnormal. Multivariable logistic regression analysis was used to test the independent predictive value of a CAC score of zero to exclude inducible myocardial ischemia.
  
  
  RESULTS
  Ninety-nine of 206 patients (48%) had a CAC score of zero and of these only 1 had inducible ischemia on PET. This yielded a negative predictive value of 99% (95% CI 95%-100%). CAC score of zero was the strongest independent predictor of a normal myocardial perfusion PET (OR = 0.05; 95% CI = 0.006-0.38; p = 0.004).
  
  
  CONCLUSIONS
  In a population of predominately intermediate likelihood of CAD, a CAC score of zero excludes inducible ischemia on myocardial perfusion PET.
authors.affiliation: Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322, USA. festeve@emory.edu
authors.forename: Fabio P
authors.initials: FP
authors.lastname: Esteves
authors.forename: Akbar
authors.initials: A
authors.lastname: Khan
authors.forename: Luis C L
authors.initials: LC
authors.lastname: Correia
authors.forename: Jonathon A
authors.initials: JA
authors.lastname: Nye
authors.forename: Raghuveer K
authors.initials: RK
authors.lastname: Halkar
authors.forename: David M
authors.initials: DM
authors.lastname: Schuster
authors.forename: Arthur
authors.initials: A
authors.lastname: Stillman
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000378:metabolism; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D049268:Positron-Emission Tomography / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D015415:Biomarkers; D002118:Calcium