title: Myocardial perfusion imaging in stable symptomatic patients with extensive coronary atherosclerosis.
abstract: OBJECTIVE
  High coronary artery calcium (CAC) scores are associated with a high likelihood of ischaemia and obstructive coronary disease. Myocardial perfusion imaging (MPI) is a key investigation to determine the need for revascularization. However, the value of MPI in presence of extensive CAC has so far only been demonstrated in asymptomatic patients, whereas its value in symptomatic patients remains largely unclear. Therefore, we studied the impact of MPI in symptomatic patients with a CAC score ≥ 1,000.
  
  
  METHODS
  We included 282 patients (mean age 69 ± 9 years, 63% men) without a history of coronary disease with suspected stable angina referred for MPI and with a CAC score ≥ 1,000. On follow-up at 18 months invasive angiography, coronary revascularization, nonfatal myocardial infarction and death were recorded.
  
  
  RESULTS
  MPI was normal in 54 %, equivocal in 10 % and abnormal in 37 % (fixed defect 9 % and ischaemia 28 %) of patients. More abnormal MPI findings were observed in men, smokers and those with even higher CAC scores. During follow-up, 1 patient (with nonischaemic MPI) died from a cardiac cause, 1 patient (with ischaemic MPI) suffered a myocardial infarction and 92 patients (33 %) underwent revascularization. Ischaemia on MPI was a strong predictor of coronary revascularization (odds ratio 13.1; 95 % CI 7.1-24.3; p < 0.001).
  
  
  CONCLUSIONS
  Ischaemia on MPI is observed in approximately 30 % of patients with a CAC score ≥ 1,000, and is a strong predictor of coronary revascularization. However, nonischaemic MPI does not exclude revascularization, and patients with persisting complaints should be considered for invasive angiography.
authors: Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011 JW, Zwolle, The Netherlands.
authors: Mohamed
authors: M
authors: Mouden
authors: Jan Paul
authors: JP
authors: Ottervanger
authors: Jorik R
authors: JR
authors: Timmer
authors: Stoffer
authors: S
authors: Reiffers
authors: Ad H J
authors: AH
authors: Oostdijk
authors: Siert
authors: S
authors: Knollema
authors: Pieter L
authors: PL
authors: Jager
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D012306:Risk; D015899:Tomography, Emission-Computed, Single-Photon
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