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Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

A limitation of stress myocardial perfusion imaging (MPI) is the inability to detect non-obstructive coronary artery disease (CAD). One advantage of MPI with a hybrid CT device is the ability to obtain same-setting measurement of the coronary artery calcium score (CACS).

Methods and Results

Utilizing our single-center nuclear database, we identified 760 consecutive patients with: (1) no CAD history; (2) a normal clinically indicated Rb-82 PET/CT stress perfusion study; and (3) a same-setting CAC scan. 487 of 760 patients (64.1%) had subclinical CAD based on an abnormal CACS. Of those with CAC, the CACS was >100, >400, and >1000 in 47.0%, 22.4%, and 8.4% of patients, respectively. Less than half of the patients with CAC were receiving aspirin or statin medications prior to PET/CT imaging. Patients with CAC were more likely to be initiated or optimized on proven medical therapy for CAD immediately following PET/CT MPI compared to those without CAC.

Conclusions

Subclinical CAD is common in patients without known CAD and normal myocardial perfusion assessed by hybrid PET/CT imaging. Identification of CAC influences subsequent physician prescribing patterns such that those with CAC are more likely to be treated with proven medical therapy for the treatment of CAD.

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Authors and Affiliations

  1. University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Kevin A. Bybee MD, John Lee MD, Richard Markiewicz MD, Ryan Longmore MD, A. Iain McGhie MD, James H. O’Keefe MD, Randall C. Thompson MD & Timothy M. Bateman MD

  2. Cardiovascular Consultants, PA, 12330 Metcalf Avenue, Suite 280, Overland Park, KS, 66213, USA

    Kevin A. Bybee MD, A. Iain McGhie MD, James H. O’Keefe MD, Randall C. Thompson MD & Timothy M. Bateman MD

  3. St. Luke’s Mid-America Heart Institute, Kansas City, MO, USA

    Kevin A. Bybee MD, John Lee MD, A. Iain McGhie MD, James H. O’Keefe MD, Kevin Kennedy MS, Randall C. Thompson MD & Timothy M. Bateman MD

  4. Cardiovascular Imaging Technologies, Kansas City, MO, USA

    Bai-Ling Hsu PhD & Timothy M. Bateman MD

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  1. Kevin A. Bybee MD
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Correspondence to Kevin A. Bybee MD.

Additional information

See related editorial, doi:10.1007/s12350-009-9185-7.

Kevin A. Bybee, Richard Markiewicz, and Timothy M. Bateman were involved in the conception, design, analysis, and interpretation of the data. They were participants in the drafting of the manuscript and approval of the manuscript in its final version. John Lee, Ryan Longmore, A. Iain McGhie, James H. O’Keefe, Bai-Ling Hsu, Kevin Kennedy, and Randall C. Thompson were involved in the design, analysis and interpretation of the data. They were participants in the critical revision of the manuscript for important intellectual content and approval of the manuscript in its final version.

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Bybee, K.A., Lee, J., Markiewicz, R. et al. Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging. J. Nucl. Cardiol. 17, 188–196 (2010). https://doi.org/10.1007/s12350-009-9159-9

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  • DOI: https://doi.org/10.1007/s12350-009-9159-9

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