Haresh Majmundar

Myocardial perfusion imaging & angiography after coronary calcium scanning in the community

Abstract Background: Studies of myocardial perfusion imaging (MPI) after coronary calcium screening (CS) have only been reported in asymptomatic subjects recruited for MPI for purposes of research. A “real world” evaluation of MPI after CS has not been reported. Methods: 175 outpatients (age 58+9 yrs; 134 M) were referred by their physicians to a community lab for MPI after CS. 129 had no symptoms, 25 noncardiac chest pain, 11 atypical angina and 10 typical angina. Stress was exercise in 159; pharmacologic in 16. Results: Agatston scores (AS) averaged 479+626 and had been performed in 32 facilities. Computed tomography (CT) was by electron beam in 42% and multidetector (MD) in 58% (whole body, 51%; heart only 49%). MPI was abnormal in 14% with AS Download : Download full-size image Conclusion: Unselected outpatients undergoing MPI after CS may be symptomatic and frequently have abnormal MPI if CS ≥100. Both FRS and CS predict risk of abnormal MPI. While the evidence available for the use of CS is generally restricted to cardiac EBCT studies, CS in the community is most often whole body and performed with MDCT. The increased radiation dose and costs and consequences of incidental non-cardiac findings of whole body MDCT should be considered when developing guidelines for the potential use of CS in screening and diagnosis of coronary artery disease.