Significance of Coronary Artery Calcifications and Ischemic Electrocardiographic Changes Among Patients Undergoing Myocardial Perfusion Imaging.

BACKGROUND

Estimation of coronary artery calcification (CAC) can provide important prognostic information in patients with suspected coronary artery disease.

OBJECTIVES

The authors aimed to investigate whether CAC evaluation offers additional insight into the association of stress electrocardiographic (ECG) changes with adverse outcomes in patients undergoing myocardial perfusion imaging (MPI).

METHODS

A total of 12,265 patients (47% female, median: 64 (56-73) years, body mass index: 29 ± 7 kg/m) who underwent exercise treadmill or regadenoson single-photon emission computed tomography/computed tomography (CT) MPI during June 2016 to May 2022 at a large academic center were retrospectively studied.

RESULTS

During the median follow-up of 1.6 (IQR: 0.5-3.0) years, the primary outcome (3-year composite of death, myocardial infarction, or coronary revascularization, major adverse cardiac event [MACE]) occurred in 1,422 patients. Within participants with normal perfusion, MACE rate was the highest in patients with CAC with or without ischemic stress ECG (9.6% and 7%, respectively), and low event rates were observed in patients without CAC with or without ischemic stress ECG (0.5% and 1.9% respectively). In a subgroup analysis, all CAC grades (mild, moderate, severe) were independently associated with worse 3-year composite endpoint rates. In multivariable analysis, the presence of CAC was associated with MACE independent of ischemic ECG changes in both the overall cohort (P < 0.001) and when restricting the analysis to patients with normal perfusion (P < 0.05).

CONCLUSIONS

In patients with normal single-photon emission computed tomography/CT MPI, CAC is strongly associated with adverse outcomes independent of ischemic ECG changes with low event rates in patients without CAC on attenuation CT irrespective of ischemic stress ECG changes.