A subgroup of patients with normal stress myocardial perfusion imaging (MPI) have obstructive coronary artery disease (CAD) on coronary computed tomographic angiography (CCTA). A retrospective study was performed to identify factors associated with obstructive CAD in patients with normal MPI. Bivariate differences between patients with obstructive (>50% stenosis) and nonobstructive (<50% stenosis) CAD were assessed. Of the 105 patients with normal MPI, 42 (40%) had obstructive CAD on CCTA. After a multivariable logistic regression analysis increased Framingham risk scores ([FRS] ≥10%) and coronary artery calcium scores ([CACS] >100 Agatston Units [AU]) were independently associated with obstructive CAD (P = .006 and P < .0001, respectively). Patients with normal MPI had 13 times and 98 times higher odds of having obstructive CAD if they had a FRS ≥10% versus <10% and CACS >100 AU versus ≤100 AU, respectively. Increased FRS and CACS may stratify patients who may benefit from further evaluation for significant CAD despite normal MPI.
SchuijfJDWijnsWJukemaJW. A comparative regional analysis of coronary atherosclerosis and calcium score on multislice CT versus myocardial perfusion on SPECT. J Nucl Med. 2006;47(11):1749–1755.
2.
GaemperliOSchepisTKoepfliP. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging. 2007;34(8):1162–1171.
3.
SchuijfJDWijnsWJukemaJW. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol. 2006;48(12):2508–2514.
4.
WilsonPWD'AgostinoRBLevyDBelangerAMSilbershatzHKannelWB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–1847.
5.
HadamitzkyMFreissmuthBMeyerT. Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease. JACC Cardiovasc Imaging. 2009;2(4):404–411.
6.
CerqueiraMDWeissmanNJDilsizianV. American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105(4):539–542.
7.
AgatstonASJanowitzWRHildnerFJZusmerNRViamonteMJrDetranoR. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15(4):827–832.
8.
BudoffMJNasirKMcClellandRL. Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2009;53(4):345–352.
9.
NasirKShawLJLiuST. Ethnic differences in the prognostic value of coronary artery calcification for all-cause mortality. J Am Coll Cardiol. 2007;50(10):953–960.
10.
HechtHSBudoffMJBermanDSEhrlichJRumbergerJA. Coronary artery calcium scanning: clinical paradigms for cardiac risk assessment and treatment. Am Heart J. 2006;151(6):1139–1146.
11.
CaraccioloEADavisKBSopkoG. Comparison of surgical and medical group survival in patients with left main equivalent coronary artery disease. Long-term CASS experience. Circulation. 1995;91(9):2335–2344.
12.
BermanDSShawLJHachamovitchR. Comparative use of radionuclide stress testing, coronary artery calcium scanning, and noninvasive coronary angiography for diagnostic and prognostic cardiac assessment. Semin Nucl Med. 2007;37(1):2–16.
13.
UnderwoodSRAnagnostopoulosCCerqueiraM. British cardiac society; british nuclear cardiology society; british nuclear medicine society; royal college of physicians of london; royal college of radiologists. Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging. 2004;31(2):261–291.
14.
AchenbachS. Computed tomography coronary angiography. J Am Coll Cardiol. 2006;48(10):1919–1928.
van WerkhovenJMSchuijfJDJukemaJW. Anatomic correlates of a normal perfusion scan using 64-slice computed tomographic coronary angiography. Am J Cardiol. 2008;101(1):40–45.
17.
ShawLJIskandrianAE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol. 2004;11(2):171–185.
18.
PundziuteGSchuijfJDJukemaJW. Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease. J Am Coll Cardiol. 2007;49(1):62–70.
19.
MinJKShawLJDevereuxRB. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50(12):1161–1170.
20.
HendelRCPatelMRKramerCMAmerican College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group;American College of RadiologySociety of Cardiovascular Computed TomographySociety for Cardiovascular Magnetic Resonance;American Society of Nuclear Cardiology;North American Society for Cardiac Imaging;Society for Cardiovascular Angiography and InterventionsSociety of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48(7):1475–1497.
21.
SchepisTGaemperliOKoepfliP. Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population. J Nucl Med. 2007;48(9):1424–1430.
22.
AlmedaFQShahRSenterS. Clinical and angiographic profile of patients with markedly elevated coronary calcium scores (>or=1000) detected by electron beam computed tomography. Cardiovasc Radiat Med. 2004;5(3):109–112.
23.
DouglasPSChenJGillamL. Achieving quality in cardiovascular imaging ii: proceedings from the second american college of cardiology—duke university medical center think tank on quality in cardiovascular imaging. JACC Cardiovasc Imaging. 2009;2(2):231–240.
