Skip to main content

Advertisement

SpringerLink
Log in

The impact of coronary calcium score as an addition to myocardial perfusion imaging in altering clinical management (ICCAMPA trial)

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Introduction: Aim

Myocardial perfusion imaging (MPI) is a key tool for the identification and risk stratification of patients with coronary artery disease. The use of a coronary calcium score further adds to prognostic data above MPI alone. In this study, our aim was to evaluate the extent to which the use of a coronary artery calcium (CAC) score, when co-reported with MPI, impacts changes in clinical management in patients without a history of coronary artery disease (CAD) undergoing functional imaging.

Methods

This is a multicenter international study which incorporated a standardized questionnaire to evaluate changes in clinician management after MPI results were given with and without the additional information of a CAC score. Calcium scoring on a SPECT-CT system was performed via a semiquantitative Shemesh score (0-12) with a 0-3 score from the left main, left anterior descending, left circumflex, and right coronary arteries. CT of the chest was read independently, and non-coronary findings were reported alongside the CAC score.

Results

A total of 281 patients were enrolled across 3 international centers (Brazil, Australia, New Zealand). Of the 281 patients, 133 (47%) had management altered after the clinician was made aware of the CAC score. The impact of the CAC in changing clinical management was significant, particularly in patients with a negative MPI (P < 0.0001), but also in MPI-positive patients (P = 0.0021). The most common management change was the addition or intensification of statin therapy.

Conclusion

The addition of the CAC component to MPI yielded significant management changes in nearly half of all patients undergoing MPI for suspected CAD. This trend was observed across all centers in the three countries involved and was particularly evident in patient with a negative MPI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7

Similar content being viewed by others

Abbreviations

CAD:

Coronary artery disease

MPI:

Myocardial perfusion imaging

CAC:

Coronary artery calcium

SPECT:

Single-photon emission computed tomography

CT:

Computed tomography

CTCA:

CT coronary angiography

CTAC:

CT attenuation correction

TTE:

Transthoracic echo

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

References

  1. Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 2004;11:171‐85.

    Article  PubMed  Google Scholar 

  2. Yokota S, et al. Coronary calcium score influences referral for invasive coronary angiography after normal myocardial perfusion SPECT. J Nucl Cardiol 2019;26:602‐12.

    Article  PubMed  Google Scholar 

  3. Dzaye O, et al. Warranty period of a calcium score of zero: Comprehensive analysis From MESA. JACC Cardiovasc Imaging 2021;14:990‐1002.

    Article  PubMed  Google Scholar 

  4. Bergstrom G, et al. Prevalence of subclinical coronary artery atherosclerosis in the general population. Circulation 2021;144:916‐29.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Oikonomou EK, et al. Perivascular fat attenuation index stratifies cardiac risk associated with high-risk plaques in the CRISP-CT study. J Am Coll Cardiol 2020;76:755‐7.

    Article  PubMed  Google Scholar 

  6. Schenker MP, et al. Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: A combined positron emission tomography/computed tomography study. Circulation 2008;117:1693‐700.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Patchett ND, Pawar S, Miller EJ. Visual identification of coronary calcifications on attenuation correction CT improves diagnostic accuracy of SPECT/CT myocardial perfusion imaging. J Nucl Cardiol 2017;24:711‐20.

    Article  PubMed  Google Scholar 

  8. Sharma V, et al. 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. J Nucl Cardiol 2019;28:2086.

    Article  PubMed  Google Scholar 

  9. Hecht H, et al. Clinical indications for coronary artery calcium scoring in asymptomatic patients: Expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2017;11:157‐68.

    Article  PubMed  Google Scholar 

  10. Mitchell JD, et al. Impact of statins on cardiovascular outcomes following coronary artery calcium scoring. J Am Coll Cardiol 2018;72:3233‐42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Arnson Y, et al. Impact of exercise on the relationship between CAC scores and all-cause mortality. JACC Cardiovasc Imaging 2017;10:1461‐8.

    Article  PubMed  Google Scholar 

  12. Henzlova MJ, et al. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol 2016;23:606‐39.

    Article  PubMed  Google Scholar 

  13. Dorbala S, et al. Single photon emission computed tomography (SPECT) myocardial perfusion imaging guidelines: instrumentation, acquisition, processing, and interpretation. J Nucl Cardiol 2018;25:1784‐846.

    Article  PubMed  Google Scholar 

  14. Tilkemeier PL, et al. ASNC imaging guidelines for nuclear cardiology procedures: Standardized reporting of nuclear cardiology procedures. J Nucl Cardiol 2017;24:2064‐128.

    Article  PubMed  Google Scholar 

  15. Cerqueira MD, et al. 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. Int J Cardiovasc Imaging 2002;18:539‐42.

    PubMed  Google Scholar 

  16. Shemesh J, et al. Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology 2010;257:541‐8.

    Article  PubMed  Google Scholar 

  17. Hecht HS, et al. Coronary artery calcium scanning: Clinical paradigms for cardiac risk assessment and treatment. Am Heart J 2006;151:1139‐46.

    Article  CAS  PubMed  Google Scholar 

  18. Min JK, et al. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol 2011;58:849‐60.

    Article  PubMed  Google Scholar 

  19. Mortensen MB, et al. Impact of plaque burden versus stenosis on ischemic events in patients with coronary atherosclerosis. J Am Coll Cardiol 2020;76:2803‐13.

    Article  PubMed  Google Scholar 

  20. Mittal TK, et al. Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score. Eur Heart J Cardiovasc Imaging 2017;18:922‐9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Maron DJ, et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med 2020;382:1395‐407.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mouden M, et al. The influence of coronary calcium score on the interpretation of myocardial perfusion imaging. J Nucl Cardiol 2014;21:368‐74.

    Article  PubMed  Google Scholar 

  23. Chang SM, et al. The coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk. J Am Coll Cardiol 2009;54:1872‐82.

    Article  PubMed  Google Scholar 

  24. Investigators S-H. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): An open-label, parallel-group, multicentre trial. Lancet 2015;385:2383‐91.

    Article  Google Scholar 

  25. Einstein AJ, et al. Agreement of visual estimation of coronary artery calcium from low-dose CT attenuation correction scans in hybrid PET/CT and SPECT/CT with standard Agatston score. J Am Coll Cardiol 2010;56:1914‐21.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kaster TS, et al. Single low-dose CT scan optimized for rest-stress PET attenuation correction and quantification of coronary artery calcium. J Nucl Cardiol 2015;22:419‐28.

    Article  PubMed  Google Scholar 

  27. Engbers EM, et al. Visual estimation of coronary calcium on computed tomography for attenuation correction. J Cardiovasc Comput Tomogr 2016;10:327‐9.

    Article  CAS  PubMed  Google Scholar 

  28. Mylonas I, et al. Measuring coronary artery calcification using positron emission tomography-computed tomography attenuation correction images. Eur Heart J Cardiovasc Imaging 2012;13:786‐92.

    Article  PubMed  Google Scholar 

  29. Schwartz J, et al. Influence of patients’ coronary artery calcium on subsequent medication use patterns. Am J Health Behav 2012;36:628‐38.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cheezum MK, et al. Changes in preventive medical therapies and CV risk factors after CT angiography. JACC Cardiovasc Imaging 2013;6:574‐81.

    Article  PubMed  Google Scholar 

  31. Hulten E, et al. Coronary artery disease detected by coronary computed tomographic angiography is associated with intensification of preventive medical therapy and lower low-density lipoprotein cholesterol. Circ Cardiovasc Imaging 2014;7:629‐38.

    Article  PubMed  Google Scholar 

  32. Emami H, et al. Nonobstructive coronary artery disease by coronary CT angiography improves risk stratification and allocation of statin therapy. JACC Cardiovasc Imaging 2017;10:1031‐8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gupta A, et al. The identification of calcified coronary plaque is associated with initiation and continuation of pharmacological and lifestyle preventive therapies: A systematic review and meta-analysis. JACC Cardiovasc Imaging 2017;10:833‐42.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schepis T, et al. 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;48:1424‐30.

    Article  PubMed  Google Scholar 

  35. Berman DS, et al. Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol 2004;44:923‐30.

    Article  CAS  PubMed  Google Scholar 

  36. Ghadri JR, et al. Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI. Heart 2011;97:998‐1003.

    Article  PubMed  Google Scholar 

  37. Engbers EM, et al. Prognostic value of coronary artery calcium scoring in addition to single-photon emission computed tomographic myocardial perfusion imaging in symptomatic patients. Circ Cardiovasc Imaging 2016. https://doi.org/10.1161/CIRCIMAGING.115.003966.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia

    Pavithra S. Jayadeva MBBS, Jessica Yao MBBS, James Westcott NMT & Nathan Better MBBS, MASNC

  2. Department of Cardiology, Palmerston North Hospital, Palmerston North, New Zealand

    Stephen Stowers MD & E. W. Tang MD

  3. Department of Nuclear Medicine, Quanta Diagnostico por Imagem, Curitiba, Brazil

    Joao Vitola MD, MASNC & Rodrigo Cerci MD

  4. Department of Nuclear Medicine, Wollongong Hospital, Wollongong, NSW, Australia

    Barry Elison MBBS

  5. Department of Medicine, The University of Melbourne, Melbourne, Australia

    Nathan Better MBBS, MASNC

  6. Departments of Nuclear Medicine and Cardiology, Royal Melbourne Hospital, Parkville, Australia

    Nathan Better MBBS, MASNC

Authors
  1. Pavithra S. Jayadeva MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen Stowers MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. W. Tang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joao Vitola MD, MASNC
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rodrigo Cerci MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jessica Yao MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James Westcott NMT
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Barry Elison MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nathan Better MBBS, MASNC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pavithra S. Jayadeva MBBS.

Ethics declarations

Disclosures

All authors have nothing to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 539 KB)

Appendix

Appendix

Below is the standardized questionnaire made available to the investigator when contacting the clinician.

figure a

First set of questions: Myocardial perfusion test result ONLY

figure b

Second set of questions: Myocardial perfusion test PLUS coronary calcium score

figure c

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jayadeva, P.S., Stowers, S., Tang, E.W. et al. The impact of coronary calcium score as an addition to myocardial perfusion imaging in altering clinical management (ICCAMPA trial). J. Nucl. Cardiol. 30, 1004–1018 (2023). https://doi.org/10.1007/s12350-022-03086-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-022-03086-2

Keywords

Search

Navigation