title: The role of calcium score and CT angiography in the medical management of patients with normal myocardial perfusion imaging.
abstract: BACKGROUND
  Individuals with normal myocardial perfusion imaging (MPI) may still have substantial coronary artery disease (CAD), which would benefit from aggressive medical therapy. The role of coronary artery calcium-score (CAC) and/or coronary CT Angiography (CTA) to identify additional treatment candidates in this population is unknown.
  
  
  METHODS
  Ninety-four patients completed the study protocol and underwent CAC and CTA after MPI.
  
  
  RESULTS
  In 81 patients who had a normal MPI, an algorithm using the clinical predictors, CAC, and then CTA was created to identify candidates for aggressive medical management; 24/81 patients had a high Framingham Risk Score (FRS) or diabetes, and need aggressive medical management, while 6/81 patients had a low FRS and low post-MPI probability of CAD. The use of CAC in 51/81 patients with intermediate clinical predictors would identify 23/51 patients with low risk (CAC < 100) and 11/51 patients (CAC > 400) for aggressive medical management. The remaining 17/51 patients with intermediate CAC scores (100-399) would require CTA, of which, would identify 8/17 additional patients with >50% stenosis for aggressive medical therapy.
  
  
  CONCLUSIONS
  A stepwise approach including history, CAC and CTA can identify about 50% of the patients with normal MPI who have a higher risk and may benefit from aggressive medical management.
authors: Vascular Research Laboratory, Providence VA Medical Center, 830 Chalkstone Ave., Providence, RI 02908, USA. Gaurav_choudhary@brown.edu
authors: Gaurav
authors: G
authors: Choudhary
authors: Victor
authors: V
authors: Shin
authors: Shahnaz
authors: S
authors: Punjani
authors: Nathan
authors: N
authors: Ritter
authors: Satish C
authors: SC
authors: Sharma
authors: Wen-Chih
authors: WC
authors: Wu
mesh_terms: D002114:Calcinosis / Q000150:complications / Q000175:diagnosis*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*