Prognostic Interplay of Coronary Artery Calcification and Underlying Vascular Dysfunction in Patients With Suspected Coronary Artery Disease

Objectives This study sought to evaluate the interrelation of atherosclerotic burden, as assessed by coronary artery calcium (CAC) score and coronary vascular function, as assessed by quantitative estimates of coronary flow reserve (CFR), with respect to prediction of clinical outcomes. Background T...

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Published in:	Journal of the American College of Cardiology 2013-05, Vol.61 (20), p.2098-2106
Main Authors:	Naya, Masanao, MD, PhD, Murthy, Venkatesh L., MD, PhD, Foster, Courtney R., RT, Gaber, Mariya, MS, Klein, Josh, BA, Hainer, Jon, BS, Dorbala, Sharmila, MD, Blankstein, Ron, MD, Di Carli, Marcelo F., MD
Format:	Article
Language:	eng
Subjects:	Aged atherosclerotic burden Biological and medical sciences Cardiac Imaging Techniques Cardiology Cardiology. Vascular system Cardiovascular Cohort Studies coronary artery calcium Coronary Artery Disease - complications Coronary Artery Disease - diagnosis Coronary Artery Disease - mortality coronary flow reserve Coronary heart disease Coronary vessels Female Heart Heart attacks Hospitalization Humans hybrid PET/CET Internal Medicine Male Medical imaging Medical sciences Middle Aged Myocardial Infarction - diagnosis Myocardial Infarction - epidemiology Myocardial Infarction - therapy Myocardial Revascularization Predictive Value of Tests Prognosis Risk Factors Tomography Vascular Calcification - complications Vascular Calcification - diagnosis Vascular Calcification - mortality
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Summary:	Objectives This study sought to evaluate the interrelation of atherosclerotic burden, as assessed by coronary artery calcium (CAC) score and coronary vascular function, as assessed by quantitative estimates of coronary flow reserve (CFR), with respect to prediction of clinical outcomes. Background The contribution of coronary vascular dysfunction, atherosclerotic burden, and the 2 combined to cardiac events is unknown. Method A total of 901 consecutive patients underwent82 Rubidium myocardial perfusion imaging (MPI) positron emission tomography (PET) and CAC scan. All patients had normal MPI. The primary endpoint was a composite of major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, late revascularization, and admission for heart failure. Results At baseline, CFR decreased (2.15 ± 0.72, 2.02 ± 0.65, and 1.88 ± 0.64, p < 0.0001) with increasing levels of CAC (0, 1 to 399, and ≥400). Over a median of 1.53 years (interquartile range: 0.77 to 2.44), there were 57 MACE. Annual risk-adjusted MACE rates were higher for patients with CFR
ISSN:	0735-1097 1558-3597