title: Impact of Gender on the Prognostic Value of Coronary Artery Calcium in Symptomatic Patients With Normal Single-Photon Emission Computed Tomography Myocardial Perfusion.
abstract: The coronary artery calcium (CAC) score provides independent prognostic value on top of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). We sought to determine whether the prognostic value of the CAC score in patients with normal SPECT MPI is gender specific. We studied 3,705 consecutive symptomatic patients without a history of coronary artery disease with normal SPECT MPI. All patients underwent concomitant CAC scoring, which was categorized as CAC score 0, 1 to 99, 100 to 399, 400 to 999, or ≥1,000. Major adverse cardiac events were defined as revascularization, nonfatal myocardial infarction, or all-cause mortality. The median CAC score was 9 in women (interquartile range 0 to 113) and 47 in men (interquartile range 1 to 307, p <0.001). The annual event rate was lower in women than in men (1.6% and 2.7%, respectively, p <0.001). When stratified by CAC score, annual event rates were similar (for women and men, respectively: CAC score 0, 0.6% and 0.5%, p = 0.95; CAC score 1 to 99, 0.9% and 1.2%, p = 0.45; CAC score 100 to 399, 2.7% and 3.8%, p = 0.23; CAC score 400 to 999, 3.8% and 5.3%, p = 0.34; CAC score ≥1,000, 8.4% and 8.7%, p = 0.99). The CAC score was an independent predictor of major adverse cardiac events in both genders (CAC score ≥1,000: hazard ratio for women 8.5, 95% confidence interval 4.0 to 18.1; hazard ratio for men 14.8, 95% confidence interval 5.3 to 41.1). In conclusion, risk for events is similar for both genders when stratified by CAC score, wherein a high CAC score carries a high risk for events despite normal SPECT MPI. Our findings do not reveal a gender-specific prognostic value of the CAC score.
authors.affiliation: Department of Cardiology, Isala, Zwolle, The Netherlands; Department of Nuclear Medicine, Isala, Zwolle, The Netherlands. Electronic address: e.engbers@isala.nl.
authors.forename: Elsemiek M
authors.initials: EM
authors.lastname: Engbers
authors.affiliation: Department of Cardiology, Isala, Zwolle, The Netherlands.
authors.forename: Jorik R
authors.initials: JR
authors.lastname: Timmer
authors.affiliation: Department of Cardiology, Isala, Zwolle, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Cardiology, Isala, Zwolle, The Netherlands; Department of Nuclear Medicine, Isala, Zwolle, The Netherlands.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mouden
authors.affiliation: Department of Nuclear Medicine, Isala, Zwolle, The Netherlands.
authors.forename: Siert
authors.initials: S
authors.lastname: Knollema
authors.affiliation: Department of Nuclear Medicine, Isala, Zwolle, The Netherlands.
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Jager
mesh_terms: D000367:Age Factors; D002114:Calcinosis / Q000175:diagnosis / Q000453:epidemiology*; D002118:Calcium / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D002118:Calcium