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Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging

OBJECTIVE: Visually estimated coronary artery calcium (VECAC) from chest CT or attenuation correction (AC)/CT obtained during positron emission tomography (PET)–myocardial perfusion imaging (MPI) is feasible. Our aim was to determine the prognostic value of VECAC beyond conventional risk factors and...

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Autores principales: Selvaraj, Senthil, Khan, Muhammad Shoaib, Vidula, Mahesh K, Wiener, Philip C, de Feria, Alejandro E, Rojulpote, Chaitanya, Krishnan, Sheela, Tamrat, Ruth, Julien, Howard, Jacoby, Douglas, Litt, Harold, Pryma, Daniel, Dubroff, Jacob, Guerraty, Marie A, Bravo, Paco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108688/
https://www.ncbi.nlm.nih.gov/pubmed/33963079
http://dx.doi.org/10.1136/openhrt-2021-001648
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author Selvaraj, Senthil
Khan, Muhammad Shoaib
Vidula, Mahesh K
Wiener, Philip C
de Feria, Alejandro E
Rojulpote, Chaitanya
Krishnan, Sheela
Tamrat, Ruth
Julien, Howard
Jacoby, Douglas
Litt, Harold
Pryma, Daniel
Dubroff, Jacob
Guerraty, Marie A
Bravo, Paco
author_facet Selvaraj, Senthil
Khan, Muhammad Shoaib
Vidula, Mahesh K
Wiener, Philip C
de Feria, Alejandro E
Rojulpote, Chaitanya
Krishnan, Sheela
Tamrat, Ruth
Julien, Howard
Jacoby, Douglas
Litt, Harold
Pryma, Daniel
Dubroff, Jacob
Guerraty, Marie A
Bravo, Paco
author_sort Selvaraj, Senthil
collection PubMed
description OBJECTIVE: Visually estimated coronary artery calcium (VECAC) from chest CT or attenuation correction (AC)/CT obtained during positron emission tomography (PET)–myocardial perfusion imaging (MPI) is feasible. Our aim was to determine the prognostic value of VECAC beyond conventional risk factors and PET imaging parameters, including coronary flow reserve (CFR). METHODS: We analysed 608 patients without known coronary artery disease who underwent PET–MPI between 2012 and 2016 and had AC/CT and/or chest CT images. We used Cox regression to estimate the association of VECAC categories (≤10, 11–400, >400 Agatston units (AU)) with the primary outcome of all-cause death, acute coronary syndrome or stroke (mean follow-up 4.3±1.8 years). C-statistics assessed the relationship between PET parameters and VECAC with the primary outcome. RESULTS: Mean age was 58±11 years, 65% were women and 67% were black. VECAC ≤10, 11–400 and >400 AU was observed in 68%, 12% and 20% of subjects, respectively. Compared with VECAC ≤10, VECAC categories 11–400 (HR 2.25, 95% CI 1.24 to 4.08) and >400 AU (HR 3.05, 95% CI 1.87 to 4.98) were associated with the primary outcome after adjusting for traditional risk factors, MPI findings and CFR. Adding VECAC to a model that included PET–MPI, CFR and clinical risk factors improved the prognostic value for the primary outcomes (c-statistic 0.71 to 0.75 with VECAC, p=0.01). CONCLUSIONS: VECAC is a potent predictor of events beyond traditional risk factors and PET imaging markers, including CFR. These data further support the importance for routine VECAC implementation.
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spelling pubmed-81086882021-05-24 Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging Selvaraj, Senthil Khan, Muhammad Shoaib Vidula, Mahesh K Wiener, Philip C de Feria, Alejandro E Rojulpote, Chaitanya Krishnan, Sheela Tamrat, Ruth Julien, Howard Jacoby, Douglas Litt, Harold Pryma, Daniel Dubroff, Jacob Guerraty, Marie A Bravo, Paco Open Heart Cardiac Risk Factors and Prevention OBJECTIVE: Visually estimated coronary artery calcium (VECAC) from chest CT or attenuation correction (AC)/CT obtained during positron emission tomography (PET)–myocardial perfusion imaging (MPI) is feasible. Our aim was to determine the prognostic value of VECAC beyond conventional risk factors and PET imaging parameters, including coronary flow reserve (CFR). METHODS: We analysed 608 patients without known coronary artery disease who underwent PET–MPI between 2012 and 2016 and had AC/CT and/or chest CT images. We used Cox regression to estimate the association of VECAC categories (≤10, 11–400, >400 Agatston units (AU)) with the primary outcome of all-cause death, acute coronary syndrome or stroke (mean follow-up 4.3±1.8 years). C-statistics assessed the relationship between PET parameters and VECAC with the primary outcome. RESULTS: Mean age was 58±11 years, 65% were women and 67% were black. VECAC ≤10, 11–400 and >400 AU was observed in 68%, 12% and 20% of subjects, respectively. Compared with VECAC ≤10, VECAC categories 11–400 (HR 2.25, 95% CI 1.24 to 4.08) and >400 AU (HR 3.05, 95% CI 1.87 to 4.98) were associated with the primary outcome after adjusting for traditional risk factors, MPI findings and CFR. Adding VECAC to a model that included PET–MPI, CFR and clinical risk factors improved the prognostic value for the primary outcomes (c-statistic 0.71 to 0.75 with VECAC, p=0.01). CONCLUSIONS: VECAC is a potent predictor of events beyond traditional risk factors and PET imaging markers, including CFR. These data further support the importance for routine VECAC implementation. BMJ Publishing Group 2021-05-07 /pmc/articles/PMC8108688/ /pubmed/33963079 http://dx.doi.org/10.1136/openhrt-2021-001648 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Cardiac Risk Factors and Prevention
Selvaraj, Senthil
Khan, Muhammad Shoaib
Vidula, Mahesh K
Wiener, Philip C
de Feria, Alejandro E
Rojulpote, Chaitanya
Krishnan, Sheela
Tamrat, Ruth
Julien, Howard
Jacoby, Douglas
Litt, Harold
Pryma, Daniel
Dubroff, Jacob
Guerraty, Marie A
Bravo, Paco
Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging
title Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging
title_full Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging
title_fullStr Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging
title_full_unstemmed Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging
title_short Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging
title_sort incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging
topic Cardiac Risk Factors and Prevention
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108688/
https://www.ncbi.nlm.nih.gov/pubmed/33963079
http://dx.doi.org/10.1136/openhrt-2021-001648
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