Key result
Abnormal SPECT and severe CACS linked to up to ~556% higher MACE risk in suspected CAD.
Why the study?
The study was conducted to evaluate the prognostic value of combining coronary artery calcium scoring and SPECT on the long-term risk of MACEs in low-risk patients with suspected CAD.
Does the combination of coronary artery calcium scoring and SPECT myocardial perfusion imaging predict major adverse cardiac events in low-risk patients with suspected coronary artery disease?
Cohort (n=1,876)
Does the combination of coronary artery calcium scoring and SPECT myocardial perfusion imaging predict major adverse cardiac events in low-risk patients with suspected coronary artery disease?
Effect estimate: HR 3.41 (95% CI 2.08-4.71)
p-value: p=<0.01
The combination of CACS and SPECT provides independent and compensatory prognostic information for predicting MACE in low-risk patients with suspected CAD.
May aid MACE risk stratification in low-risk suspected CAD; leaves open whether imaging improves outcomes.
Background: To explore the prognostic value of combination of coronary artery calcium scoring (CACS) and single-photon emission computed tomography (SPECT) on the long-term risk of major adverse cardiac events (MACEs) in Chinese patients at low risk of suspected coronary artery disease (CAD).Methods: The medical records of 1876 adult patients who were referred for clinically indicated non-invasive CAD detection with SPECT/CT from January 2011 to December 2013 were retrospectively reviewed. The primary outcome was the occurrence of MACEs, including cardiac death, non-fatal myocardial infarction (MI), unstable angina (UA), and late revascularisation.Results: During a median follow-up of 28.4 ± 9.1 months, 210 patients were identified to have at least one MACEs. Multivariate Cox regression analysis showed that patients with abnormal SPECT had more MACEs compared to those with normal SPECT (HR = 3.41, 95% CI: 2.08–4.71, p < .01). Both moderate (HR = 3.35, 95% CI: 1.76–4.32, p < .01) and severe CACS (HR = 6.56, 95% CI: 4.71–8.23, p < .01) were associated with occurrence of HACEs compared with normal CACS. Moreover, interaction terms for CACS and SPECT findings were reported to be significantly associated with MACE outcomes (p < .01).Conclusions: CACS and SPECT provided both independent and compensatory prognostic information for risk of MACE in patients at low risk of suspected CAD. Our findings strongly support adding a CACS testing in addition to SPECT in asymptomatic patients to better define the risk of cardiac events during follow-up.
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Huang et al. (2018) conducted a cohort in suspected coronary artery disease (n=1,876). Coronary artery calcium scoring (CACS) and SPECT vs. Normal CACS and normal SPECT was evaluated on Major adverse cardiac events (cardiac death, non-fatal MI, unstable angina, and late revascularisation) (HR 3.41, 95% CI 2.08-4.71, p=<0.01). Abnormal SPECT (HR 3.41; 95% CI 2.08-4.71) and severe CACS (HR 6.56; 95% CI 4.71-8.23) were significantly associated with an increased risk of MACE in low-risk patients with suspected CAD.
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