May 17, 2026Journal of the American College of Cardiology
The Coronary Artery Calcium Score and Stress Myocardial Perfusion Imaging Provide Independent and Complementary Prediction of Cardiac Risk
Key result
Severe CAC despite normal SPECT linked to ~255% higher cardiac event risk versus minimal CAC.
- 3.55-fold relative increase
- P<0.001
- n=1,126
Why the study?
CACS and SPECT both provide prognostic information, but whether integrating these tests better predicts short- and long-term cardiac events was unclear.
Do coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk in asymptomatic subjects without previous cardiovascular disease?
Population
1,126 generally asymptomatic subjects without previous cardiovascular disease
Comparison
Risk prediction across CACS categories and stress SPECT results
Design
Cohort study
Follow-up
Median 6.9 years
Authors
Discussion
Loading...
Member takes
Implication
May refine long-term risk assessment when SPECT is normal; leaves open whether CACS integration alters management.
Key Points
- To examine whether combining coronary artery calcium scoring with stress single-photon emission computed tomography improves short- and long-term cardiac risk prediction.
- Follow-up cohort study of 1,126 generally asymptomatic individuals without prior cardiovascular disease who underwent coronary artery calcium scoring (CACS) and stress single-photon emission computed tomography (SPECT) within a median of 56 days.
- Tracked participants over a median follow-up of 6.9 years for endpoints of total cardiac events and all-cause death or myocardial infarction (MI).
- Abnormal SPECT rates increased progressively with higher CACS, from <1% in subjects with CACS ≤10 to 29% in those with CACS >400 (p < 0.001).
- Total cardiac events and all-cause death/MI rates increased significantly with rising CACS and abnormal SPECT results (p < 0.001).
- Among subjects with normal SPECT scans, severe CACS (>400) versus minimal CACS (≤10) was associated with a 3.55-fold relative increase in total cardiac events and a 2.75-fold relative increase in death/MI.
Study Design
Type
Cohort (n=1,126)
Structured PICO
Do coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk in asymptomatic subjects without previous cardiovascular disease?
P
Population
1,126 generally asymptomatic subjects without previous cardiovascular disease
I
Intervention
Coronary artery calcium score (CACS) and stress single-photon emission computed tomography (SPECT) scan
O
Outcome
Total cardiac events and all-cause death/myocardial infarction (MI)composite
Main Result
Effect estimate: 3.55-fold relative increase
p-value: p=<0.001
CACS provides independent and complementary prognostic information to SPECT imaging, identifying high long-term cardiac risk even in patients with normal SPECT results.
Cite This Study
Chang et al. (2009) conducted a cohort in Asymptomatic without previous cardiovascular disease (n=1,126). Coronary artery calcium score (CACS) and stress SPECT vs. Minimal CACS (≤10) was evaluated on Total cardiac events and all-cause death/myocardial infarction (3.55-fold relative increase, p=<0.001). A severe coronary artery calcium score (>400) in subjects with a normal SPECT result was associated with a 3.55-fold relative increase in any cardiac event compared to a minimal score (≤10).