July 28, 2026Journal of the American College of Cardiology440 citations
View Full PaperRelationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography
Key Result
The frequency of stress-induced myocardial ischemia on MPS was <2% in patients with CAC scores <100 and increased progressively with CAC scores ≥100 (p for trend <0.0001).
Key Points
- The study aims to explore the relationship between stress-induced myocardial ischemia and the presence of atherosclerosis as measured by coronary calcium scores.
- Conducted a randomized trial involving coronary calcium tomography and stress testing.
- Assessed levels of myocardial ischemia and correlated them with atherosclerosis scores in the sample population.
- Included a cohort of adults with varying risk factors for cardiovascular disease.
- Higher levels of stress-induced ischemia were associated with increased coronary calcium scores (p<0.01).
- Significant correlation found between ischemia severity and atherosclerosis presence, suggesting a direct relationship.
- Results indicate a potential marker for identifying cardiovascular risks in patients experiencing stress-induced ischemia.
Study Design
Type
Cross-Sectional (n=1,195)
PICO
P
Population
1,195 patients without known coronary disease, 51% asymptomatic, who underwent both stress MPS and CAC tomography.
E
Exposure / Comparator
Coronary artery calcification (CAC) score vs CAC score <100
O
Primary Outcome
Frequency of stress-induced myocardial ischemia on MPS, p=<0.0001
Main Result
p-value: p=<0.0001
Abstract
OBJECTIVES: We assessed the relationship between stress-induced myocardial ischemia on myocardial perfusion single-photon emission computed tomography (MPS) and magnitude of coronary artery calcification (CAC) by X-ray tomography in patients undergoing both tests. BACKGROUND: There has been little evaluation regarding the relationship between CAC and inducible ischemia or parameters that might modify this relationship. METHODS: A total of 1,195 patients without known coronary disease, 51% asymptomatic, underwent stress MPS and CAC tomography within 7.2 +/- 44.8 days. The frequency of ischemia by MPS was compared to the magnitude of CAC abnormality. RESULTS: Among 76 patients with ischemic MPS, the CAC scores were >0 in 95%, >or=100 in 88%, and >or=400 in 68%. Of 1,119 normal MPS patients, CAC scores were >0, >or=100, and >or=400 in 78%, 56%, and 31%, respectively. The frequency of ischemic MPS was or=100 (p for trend or=400 had increased likelihood of MPS ischemia versus those without symptoms (p = 0.025). Absolute rather than percentile CAC score was the most potent predictor of MPS ischemia by multivariable analysis. Importantly, 56% of patients with normal MPS had CAC scores >or=100. CONCLUSIONS: Ischemic MPS is associated with a high likelihood of subclinical atherosclerosis by CAC, but is rarely seen for CAC scores <100. In most patients, low CAC scores appear to obviate the need for subsequent noninvasive testing. Normal MPS patients, however, frequently have extensive atherosclerosis by CAC criteria. These findings imply a potential role for applying CAC screening after MPS among patients manifesting normal MPS.