The Additive Prognostic Value of Coronary Calcium Score (CCS) to Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT-MPI)-real World Data from a Single Center

Overview

Journal J Nucl Cardiol

Specialty Cardiology & Vascular Diseases

Date 2019 Dec 5

PMID 31797319

Citations 10

Authors

Vinoda Sharma

Lal Mughal

Gerasimos Dimitropoulos

Awais Sheikh

Michael Griffin

Alexandra Moss

Alp Notghi

Manish Pandit

Derek L Connolly

Chetan Varma

Paulus Kirchhof

Affiliations

Soon will be listed here.

Abstract

Aims: Single-photon emission computed tomography myocardial perfusion imaging [SPECT-MPI] is a functional test for coronary ischemia. We aimed to assess the additive prognostic value of coronary calcium score (CCS) to SPECT-MPI in stable patients.

Methods: This study is a retrospective analysis of 655 patients who underwent SPECT-MPI with CCS (2012 to 2017). Receiver operator characteristic (ROC) identified CCS cutoff value for all-cause mortality: CCS+ if > cutoff value and MPI+ if ≥ 5% total perfusion defect (TPD). Patients were divided into 1 MPI-/CCS-; 2 MPI+/CCS-; 3 MPI-/CCS+; 4 MPI+/CCS+ and compared. Cox proportional hazard analysis identified predictors of mortality.

Results: CCS cutoff for all-cause mortality was > 216 (C statistic 0.756, P < 0.0001). In MPI+ groups, mean TPD was similar (13.4% and 13.1% respectively) but mortality was higher in the CCS+ (12.5% vs. 4.8%, P = 0.22) as was the severe LV systolic dysfunction (8.0% vs. 0%, P = 0.095). In MPI- groups, mean TPD was similar (0.7% and 0.9% respectively) but all-cause mortality was higher in the CCS+ (10.7% vs. 1.6%, P < 0.0001) as was severe LVSD (2.9 % vs. 0.3% P = 0.016). Age, smoking, renal impairment ,and CCS > 216 were independent predictors of mortality.

Conclusions: Patients with raised CCS on SPECT-MPI have increased mortality and poor LV function despite a negative MPI.

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References

Greenland P, Labree L, Azen S, Doherty T, Detrano R . Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004; 291(2):210-5. DOI: 10.1001/jama.291.2.210. View

Jang J, Krishnaswami A, Hung Y . Predictive values of Framingham risk and coronary artery calcium scores in the detection of obstructive CAD in patients with normal SPECT. Angiology. 2011; 63(4):275-81. DOI: 10.1177/0003319711415392. View

Detrano R, Guerci A, Carr J, Bild D, Burke G, Folsom A . Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008; 358(13):1336-45. DOI: 10.1056/NEJMoa072100. View

Budoff M, Mayrhofer T, Ferencik M, Bittner D, Lee K, Lu M . Prognostic Value of Coronary Artery Calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation. 2017; 136(21):1993-2005. PMC: 5698136. DOI: 10.1161/CIRCULATIONAHA.117.030578. View

Kwok Y, Kim C, Grady D, Segal M, Redberg R . Meta-analysis of exercise testing to detect coronary artery disease in women. Am J Cardiol. 1999; 83(5):660-6. DOI: 10.1016/s0002-9149(98)00963-1. View

Schwartz J, Johnson R, Aepfelbacher F, Parker J, Chen L, Azar R . Sensitivity, specificity and accuracy of stress SPECT myocardial perfusion imaging for detection of coronary artery disease in the distribution of first-order branch vessels, using an anatomical matching of angiographic and perfusion data. Nucl Med Commun. 2003; 24(5):543-9. DOI: 10.1097/00006231-200305000-00010. View

Iskandar A, Limone B, Parker M, Perugini A, Kim H, Jones C . Gender differences in the diagnostic accuracy of SPECT myocardial perfusion imaging: a bivariate meta-analysis. J Nucl Cardiol. 2012; 20(1):53-63. DOI: 10.1007/s12350-012-9646-2. View

Green R, Cantoni V, Acampa W, Assante R, Zampella E, Nappi C . Prognostic value of coronary flow reserve in patients with suspected or known coronary artery disease referred to PET myocardial perfusion imaging: A meta-analysis. J Nucl Cardiol. 2019; 28(3):904-918. DOI: 10.1007/s12350-019-02000-7. View

De Lorenzo A, Lima R, Siqueira-Filho A, Pantoja M . Prevalence and prognostic value of perfusion defects detected by stress technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography in asymptomatic patients with diabetes mellitus and no known coronary artery disease. Am J Cardiol. 2002; 90(8):827-32. DOI: 10.1016/s0002-9149(02)02702-9. View

10.

Anagnostopoulos C, Harbinson M, Kelion A, Kundley K, Loong C, Notghi A . Procedure guidelines for radionuclide myocardial perfusion imaging. Nucl Med Commun. 2003; 24(10):1105-19. DOI: 10.1097/01.mnm.0000095842.16659.4d. View

11.

Notghi A, Williams N, Smith N, Goyle S, Harding L . Relationship between myocardial counts and patient weight: adjusting the injected activity in myocardial perfusion scans. Nucl Med Commun. 2002; 24(1):55-9. DOI: 10.1097/00006231-200301000-00015. View

12.

Shaw L, Berman D, Maron D, Mancini G, Hayes S, Hartigan P . Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008; 117(10):1283-91. DOI: 10.1161/CIRCULATIONAHA.107.743963. View

13.

Hachamovitch R, Hayes S, Friedman J, Cohen I, Berman D . Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003; 107(23):2900-7. DOI: 10.1161/01.CIR.0000072790.23090.41. View

14.

Berman D, Abidov A, Kang X, Hayes S, Friedman J, Sciammarella M . Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. J Nucl Cardiol. 2004; 11(4):414-23. DOI: 10.1016/j.nuclcard.2004.03.033. View

15.

Budoff M, Shaw L, Liu S, Weinstein S, Mosler T, Tseng P . Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007; 49(18):1860-70. DOI: 10.1016/j.jacc.2006.10.079. View

16.

Villines T, Hulten E, Shaw L, Goyal M, Dunning A, Achenbach S . Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography.... J Am Coll Cardiol. 2011; 58(24):2533-40. DOI: 10.1016/j.jacc.2011.10.851. View

17.

Chang S, Nabi F, Xu J, Peterson L, Achari A, Pratt C . The coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk. J Am Coll Cardiol. 2009; 54(20):1872-82. DOI: 10.1016/j.jacc.2009.05.071. View

18.

Shaw L, Giambrone A, Blaha M, Knapper J, Berman D, Bellam N . Long-Term Prognosis After Coronary Artery Calcification Testing in Asymptomatic Patients: A Cohort Study. Ann Intern Med. 2015; 163(1):14-21. DOI: 10.7326/M14-0612. View

19.

Ghadri J, Pazhenkottil A, Nkoulou R, Goetti R, Buechel R, Husmann L . Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI. Heart. 2011; 97(12):998-1003. DOI: 10.1136/hrt.2010.217281. View

20.

Thompson R, McGhie A, Moser K, OKeefe Jr J, Stevens T, House J . Clinical utility of coronary calcium scoring after nonischemic myocardial perfusion imaging. J Nucl Cardiol. 2005; 12(4):392-400. DOI: 10.1016/j.nuclcard.2005.04.006. View