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Myocardial perfusion imaging in stable symptomatic patients with extensive coronary atherosclerosis

European Journal of Nuclear Medicine and Molecular Imaging volume 41, pages 136–143 (2014)Cite this article

Abstract

Purpose

High coronary artery calcium (CAC) scores are associated with a high likelihood of ischaemia and obstructive coronary disease. Myocardial perfusion imaging (MPI) is a key investigation to determine the need for revascularization. However, the value of MPI in presence of extensive CAC has so far only been demonstrated in asymptomatic patients, whereas its value in symptomatic patients remains largely unclear. Therefore, we studied the impact of MPI in symptomatic patients with a CAC score ≥1,000.

Methods

We included 282 patients (mean age 69 ± 9 years, 63 % men) without a history of coronary disease with suspected stable angina referred for MPI and with a CAC score ≥1,000. On follow-up at 18 months invasive angiography, coronary revascularization, nonfatal myocardial infarction and death were recorded.

Results

MPI was normal in 54 %, equivocal in 10 % and abnormal in 37 % (fixed defect 9 % and ischaemia 28 %) of patients. More abnormal MPI findings were observed in men, smokers and those with even higher CAC scores. During follow-up, 1 patient (with nonischaemic MPI) died from a cardiac cause, 1 patient (with ischaemic MPI) suffered a myocardial infarction and 92 patients (33 %) underwent revascularization. Ischaemia on MPI was a strong predictor of coronary revascularization (odds ratio 13.1; 95 % CI 7.1–24.3; p < 0.001).

Conclusion

Ischaemia on MPI is observed in approximately 30 % of patients with a CAC score ≥1,000, and is a strong predictor of coronary revascularization. However, nonischaemic MPI does not exclude revascularization, and patients with persisting complaints should be considered for invasive angiography.

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Affiliations

  1. Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011 JW, Zwolle, The Netherlands

    Mohamed Mouden, Jan Paul Ottervanger & Jorik R. Timmer

  2. Department of Nuclear Medicine, Isala Klinieken, Zwolle, The Netherlands

    Mohamed Mouden, Stoffer Reiffers, Ad H. J. Oostdijk, Siert Knollema & Pieter L. Jager

Authors
  1. Mohamed Mouden
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  2. Jan Paul Ottervanger
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  3. Jorik R. Timmer
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  4. Stoffer Reiffers
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  5. Ad H. J. Oostdijk
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Correspondence to Jan Paul Ottervanger.

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Mouden, M., Ottervanger, J.P., Timmer, J.R. et al. Myocardial perfusion imaging in stable symptomatic patients with extensive coronary atherosclerosis. Eur J Nucl Med Mol Imaging 41, 136–143 (2014). https://doi.org/10.1007/s00259-013-2539-z

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  • DOI: https://doi.org/10.1007/s00259-013-2539-z

Keywords

  • Single photon emission computed tomography
  • Myocardial perfusion imaging
  • Coronary artery calcium scoring
  • Coronary artery disease