Relationship between ischaemia, coronary artery calcium scores, and major adverse cardiovascular events

Abstract

Aims Positron emission tomography (PET) myocardial perfusion imaging (MPI) is often combined with coronary artery calcium (CAC) scanning, allowing for a combined anatomic and functional assessment. We evaluated the independent prognostic value of quantitative assessment of myocardial perfusion and CAC scores in patients undergoing PET. Methods and results Consecutive patients who underwent Rb-82 PET with CAC scoring between 2010 and 2018, with follow-up for major adverse cardiovascular events (MACE), were identified. Perfusion was quantified automatically with total perfusion deficit (TPD). Our primary outcome was MACE including all-cause mortality, myocardial infarction (MI), admission for unstable angina, and late revascularization. Associations with MACE were assessed using multivariable Cox models adjusted for age, sex, medical history, and MPI findings including myocardial flow reserve. In total, 2507 patients were included with median age 70. During median follow-up of 3.9 years (interquartile range 2.1–6.1), 594 patients experienced at least one MACE. Increasing CAC and ischaemic TPD were associated with increased MACE, with the highest risk associated with CAC > 1000 [adjusted hazard ratio (HR) 1.67, 95% CI 1.24–2.26] and ischaemic TPD > 10% (adjusted HR 1.80, 95% CI 1.40–2.32). Ischaemic TPD and CAC improved overall patient classification, but ischaemic TPD improved classification of patients who experienced MACE while CAC mostly improved classification of low-risk patients. Conclusions Ischaemic TPD and CAC were independently associated with MACE. Combining extent of atherosclerosis and functional measures improves the prediction of MACE risk, with CAC 0 identifying low-risk patients and regional ischaemia identifying high-risk patients in those with CAC > 0.

Coronary Artery Calcium (CAC) Score for Cardiovascular Risk Stratification in a Thai Clinical Cohort: A Comparison of Absolute Scores and Age-Sex Specific Percentiles

“…However, the data was obtained from routine standardized forms with only a small proportion of missing values, and almost all variables were objective. Second, our institution had a higher rate of revascularization, accounting for 73% of all MACE, compared to other centers where it ranged from 6-42% [35][36][37]. This indicates that a high CAC score may have served as a guide for a signi cant number of revascularizations in our study, potentially in ating the incidence of MACE.…”

Myocardial Flow Reserve, an Independent Prognostic Marker of All-Cause Mortality Assessed by 82 Rb PET Myocardial Perfusion Imaging: A Danish Multicenter Study

“…We did not have adequate statistical strength to perform stratified CACS analyses; however, recent studies have reported higher annualized rates of cardiac events in patients with impaired MFR across all groups of CACS (0, 1-99, 100-399, and >399), highlighting the independent predictive value of MFR. 27,28 We report MFR to hold prognostic value for noncardiac death independently of reversible perfusion defects. One possible explanation for the association could be linked to systemic inflammation, as seen in patients with CMD 29 and rheumatoid arthritis.…”

“…We did not have adequate statistical strength to perform stratified CACS analyses; however, recent studies have reported higher annualized rates of cardiac events in patients with impaired MFR across all groups of CACS (0, 1–99, 100–399, and >399), highlighting the independent predictive value of MFR. 27,28…”

Coronary artery calcium among patients with heterozygous familial hypercholesterolaemia

“… 13 So, CAC has been shown not only as a good surrogate marker for the development of atherosclerosis but also as a good biomarker for risk stratification of cardiovascular disease (CVD) events among the general population (non-FH patients). 14 However, data on the effects of CAC on the FH phenotype are limited. 15 , 16 We aimed to determine if CAC is associated with CVD events, defined as CVD-related death, unstable angina, myocardial infarction, or staged revascularization among patients with heterozygous FH (HeFH) under primary prevention settings.…”