Abstract
BackgroundCoronary artery calcium (CAC) score has shown to provide incremental prognostic information when added to the Framingham risk score. Although the relation between CAC and myocardial ischemia has been evaluated, there has been little evaluation of the relationship between CAC score and inducible myocardial ischemia on computed tomography myocardial perfusion (CTP). Methods and ResultsPatients who were referred with stable chest pain from the outpatient clinic and who underwent non-contrast computed tomography scan, coronary computed tomography angiography, and adenosine stress CTP were included in this study. CAC score was subdivided in four groups (1 to 99; 100 to 399, 400 to 999, and ≥ 1000). Inducible myocardial ischemia was considered when reversible perfusion defects were observed in ≥ 1 segment. A total of 131 patients (age 62 ± 9.4 years; 56% male) were included. The median CAC score was 241 (73 to 539). Forty-nine patients (37%) had evidence of inducible myocardial ischemia. The presence of inducible myocardial ischemia increased with increasing CAC score from 22% in the CAC score 1 to 99 subgroup to 35, 47, and 65% in the 100 to 399, 400 to 999, and ≥ 1000 CAC score subgroup, respectively. In multivariable analysis CAC score was the only determinant that significantly predicted the presence of inducible myocardial ischemia on CTP. ConclusionsIn a population of symptomatic patients, the majority of patients with extensive calcification had evidence of inducible myocardial ischemia on CTP. CAC score was the only independent predictor of inducible myocardial ischemia on CTP.
Highlights
Patients who were referred with stable chest pain from the outpatient clinic and who underwent non-contrast computed tomography scan, coronary computed tomography angiography, and adenosine stress computed tomography myocardial perfusion (CTP) were included in this study
The presence of inducible myocardial ischemia increased with increasing CAC score from 22% in the CAC score 1 to subgroup to 35, 47, and 65% in the to 399, 400 to 999, and ‡ 1000 CAC score subgroup, respectively
CAC score was an independent predictor of inducible myocardial ischemia on CTP
Summary
Coronary artery calcium (CAC) score measures calcification in the coronary arterial wall along the whole coronary artery tree and is a good indicator of the extent of coronary artery disease (CAD).[1,2] CAC score has shown excellent prognostic value in asymptomatic patients and has shown its prognostic value in patients with stable chest pain.[3,4,5,6,7,8,9,10,11,12,13,14] The degree of CAC correlates well with inducible myocardial ischemia as assessed on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).[15,16,17] Computed tomography (CT) myocardial perfusion (CTP) provides functional information of coronary stenosis.[18] Previous studies have advocated not to perform coronary computed tomography angiography (CTA) when high CAC score is present but straight away CTP.[19,20] no studies have assessed the direct relation of CAC score and inducible myocardial ischemia on CTP. The relation between CAC and myocardial ischemia has been evaluated, there has been little evaluation of the relationship between CAC score and inducible myocardial ischemia on computed tomography myocardial perfusion (CTP)
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