title: Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients.
abstract: BACKGROUND
  The prognostic value of coronary artery calcium (CAC) scoring on top of myocardial perfusion imaging with single-photon emission computed tomography (SPECT) in patients suspected for coronary artery disease is not well established.
  
  
  RESULTS
  Four thousand eight hundred ninety-seven symptomatic patients without a history of coronary artery disease referred for SPECT and CAC scoring were included. Major adverse cardiac events (MACEs) were defined as late revascularization (>90 days after scanning), nonfatal myocardial infarction, and all-cause mortality. The frequency of abnormal SPECT increased with higher CAC scores, from 12% in patients with CAC scores of 0 to 19%, 32%, 37%, and 50% among those with CAC scores 1 to 99, 100 to 399, 400 to 999, and ≥1000, respectively (P<0.001). During a median follow-up of 940 days (25th to 75th percentile, 581-1377), a total of 278 MACEs were observed. Overall incidence of MACE was 2.3% per year. A stepwise increase of MACE was present with increasing CAC scores, both in patients with normal SPECT (annual event rate CAC score 0: 0.6%; CAC score ≥1000: 5.5%) and abnormal SPECT (annual event rate CAC score 0: 0.4%; CAC score ≥1000: 7.6%). After multivariate analysis, both SPECT and CAC score were independent predictors of MACE (CAC score ≥1000: hazard ratio, 7.7; P<0.001 and large perfusion defect on SPECT: hazard ratio, 3.7; P<0.001).
  
  
  CONCLUSIONS
  CAC score and SPECT are independent predictors of MACE in patients suspected for coronary artery disease. Our findings strongly support performing a CAC score in addition to SPECT in symptomatic patients to better define the risk of events during follow-up.
authors.affiliation: From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands. e.engbers@isala.nl.
authors.forename: Elsemiek M
authors.initials: EM
authors.lastname: Engbers
authors.affiliation: From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands.
authors.forename: Jorik R
authors.initials: JR
authors.lastname: Timmer
authors.affiliation: From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mouden
authors.affiliation: From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands.
authors.forename: Siert
authors.initials: S
authors.lastname: Knollema
authors.affiliation: From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands.
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Jager
mesh_terms: D000368:Aged; D002423:Cause of Death; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009204:Myocardial Revascularization; D009426:Netherlands; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D013997:Time Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy
keywords: coronary artery disease; incidence; myocardial infarction; prognosis; tomography, emission-computed, single-photon