TY - JOUR
T1 - Incorporating coronary artery calcium scoring in the prediction of obstructive coronary artery disease with myocardial ischemia
T2 - a study with sequential use of coronary computed tomography angiography and positron emission tomography imaging
AU - van den Hoogen, Inge J.
AU - Wang, Xu
AU - Butcher, Steele C.
AU - Maaniitty, Teemu
AU - Schultz, Jussi
AU - van Rosendael, Alexander R.
AU - Saraste, Antti
AU - Knuuti, Juhani
AU - Bax, Jeroen J.
N1 - Funding Information:
Funding: Dr. Butcher received funding from European Society of Cardiology (ESC Research Grant App000080404).
Publisher Copyright:
© 2022, The Author(s).
PY - 2023/2
Y1 - 2023/2
N2 - Background: Additional strategies are needed to refine the referral for diagnostic testing of symptomatic patients with suspected coronary artery disease (CAD). We aimed to compare various models to predict hemodynamically obstructive CAD. Methods and results: Symptomatic patients with suspected CAD who underwent coronary artery calcium scoring (CACS) and sequential coronary computed tomography angiography (CCTA) and [15O]H2O positron emission tomography (PET) myocardial perfusion imaging were analyzed. Obstructive CAD was defined as a suspected coronary artery stenosis on CCTA with myocardial ischemia on PET (absolute stress myocardial perfusion ≤ 2.4 mL/g/min in ≥ 1 segment). Three models were developed to predict obstructive CAD-induced myocardial ischemia using logistic regression analysis: (1) basic model: including age, sex and cardiac symptoms, (2) risk factor model: adding number of risk factors to the basic model, and (3) CACS model: adding CACS to the risk factor model. Model performance was evaluated using discriminatory ability with area under the receiver-operating characteristic curves (AUC). A total of 647 patients (mean age 62 ± 9 years, 45% men) underwent CACS and sequential CCTA and PET myocardial perfusion imaging. Obstructive CAD with myocardial ischemia on PET was present in 151 (23%) patients. CACS was independently associated with myocardial ischemia (P <.001). AUC for the discrimination of ischemia for the CACS model was superior over the basic model and risk factor model (P <.001). Conclusions: Adding CACS to the model including age, sex, cardiac symptoms and number of risk factors increases the accuracy to predict obstructive CAD with myocardial ischemia on PET in symptomatic patients with suspected CAD.
AB - Background: Additional strategies are needed to refine the referral for diagnostic testing of symptomatic patients with suspected coronary artery disease (CAD). We aimed to compare various models to predict hemodynamically obstructive CAD. Methods and results: Symptomatic patients with suspected CAD who underwent coronary artery calcium scoring (CACS) and sequential coronary computed tomography angiography (CCTA) and [15O]H2O positron emission tomography (PET) myocardial perfusion imaging were analyzed. Obstructive CAD was defined as a suspected coronary artery stenosis on CCTA with myocardial ischemia on PET (absolute stress myocardial perfusion ≤ 2.4 mL/g/min in ≥ 1 segment). Three models were developed to predict obstructive CAD-induced myocardial ischemia using logistic regression analysis: (1) basic model: including age, sex and cardiac symptoms, (2) risk factor model: adding number of risk factors to the basic model, and (3) CACS model: adding CACS to the risk factor model. Model performance was evaluated using discriminatory ability with area under the receiver-operating characteristic curves (AUC). A total of 647 patients (mean age 62 ± 9 years, 45% men) underwent CACS and sequential CCTA and PET myocardial perfusion imaging. Obstructive CAD with myocardial ischemia on PET was present in 151 (23%) patients. CACS was independently associated with myocardial ischemia (P <.001). AUC for the discrimination of ischemia for the CACS model was superior over the basic model and risk factor model (P <.001). Conclusions: Adding CACS to the model including age, sex, cardiac symptoms and number of risk factors increases the accuracy to predict obstructive CAD with myocardial ischemia on PET in symptomatic patients with suspected CAD.
KW - Coronary artery calcium scoring
KW - Coronary artery disease
KW - Coronary computed tomography angiography
KW - Myocardial ischemia
KW - Myocardial perfusion imaging
KW - Positron emission tomography
UR - http://www.scopus.com/inward/record.url?scp=85141973904&partnerID=8YFLogxK
U2 - 10.1007/s12350-022-03132-z
DO - 10.1007/s12350-022-03132-z
M3 - Article
C2 - 36380207
AN - SCOPUS:85141973904
VL - 30
SP - 178
EP - 188
JO - Journal of Nuclear Cardiology
JF - Journal of Nuclear Cardiology
SN - 1071-3581
IS - 1
ER -