Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography

J Am Coll Cardiol. 2004 Aug 18;44(4):923-30. doi: 10.1016/j.jacc.2004.06.042.


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 <2% with CAC scores <100 and increased progressively with CAC >or=100 (p for trend <0.0001). Patients with symptoms with CAC scores >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.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Coronary Artery Disease / diagnostic imaging*
  • Exercise Test
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnostic imaging*
  • Predictive Value of Tests
  • ROC Curve
  • Sensitivity and Specificity
  • Thallium Radioisotopes
  • Tomography, Emission-Computed, Single-Photon
  • Tomography, X-Ray Computed*


  • Thallium Radioisotopes