title: Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging.
abstract: BACKGROUND
  A limitation of stress myocardial perfusion imaging (MPI) is the inability to detect non-obstructive coronary artery disease (CAD). One advantage of MPI with a hybrid CT device is the ability to obtain same-setting measurement of the coronary artery calcium score (CACS).
  
  
  RESULTS
  Utilizing our single-center nuclear database, we identified 760 consecutive patients with: (1) no CAD history; (2) a normal clinically indicated Rb-82 PET/CT stress perfusion study; and (3) a same-setting CAC scan. 487 of 760 patients (64.1%) had subclinical CAD based on an abnormal CACS. Of those with CAC, the CACS was > or =100, > or =400, and > or =1000 in 47.0%, 22.4%, and 8.4% of patients, respectively. Less than half of the patients with CAC were receiving aspirin or statin medications prior to PET/CT imaging. Patients with CAC were more likely to be initiated or optimized on proven medical therapy for CAD immediately following PET/CT MPI compared to those without CAC.
  
  
  CONCLUSIONS
  Subclinical CAD is common in patients without known CAD and normal myocardial perfusion assessed by hybrid PET/CT imaging. Identification of CAC influences subsequent physician prescribing patterns such that those with CAC are more likely to be treated with proven medical therapy for the treatment of CAD.
authors.affiliation: University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. Kbybee@cc-pc.com
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Bybee
authors.forename: John
authors.initials: J
authors.lastname: Lee
authors.forename: Richard
authors.initials: R
authors.lastname: Markiewicz
authors.forename: Ryan
authors.initials: R
authors.lastname: Longmore
authors.forename: A Iain
authors.initials: AI
authors.lastname: McGhie
authors.forename: James H
authors.initials: JH
authors.lastname: O'Keefe
authors.forename: Bai-Ling
authors.initials: BL
authors.lastname: Hsu
authors.forename: Kevin
authors.initials: K
authors.lastname: Kennedy
authors.forename: Randall C
authors.initials: RC
authors.lastname: Thompson
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Bateman
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000473:pathology; D002118:Calcium / Q000378:metabolism*; D003198:Computer Simulation; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D010477:Perfusion; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D002118:Calcium