Risk stratification of CAD with SPECT-MPI in women with known estrogen status

Prediction of Major Adverse Coronary Events Using the Coronary Risk Score in Women

Purpose To establish a COronary Risk Score in WOmen (CORSWO) to predict major adverse coronary events (MACE). Materials and Methods This retrospective analysis included 2226 female individuals (mean age, 66.7 years ± 11.6 [SD]) from a cohort of 25 943 consecutive patients referred for clinical gated SPECT myocardial perfusion imaging (gSPECT MPI). During the follow-up (mean, 4 years ± 2.7) after gSPECT MPI, occurrence of MACE (unstable angina requiring hospitalization, nonfatal myocardial infarction, coronary revascularization, cardiac death) was assessed. The patients were divided into training (n = 1460) and validation (n = 766) groups. To obtain the predictor model, multiple Cox regression analyses were performed. Results In the training group, 148 female individuals had MACE (2.6% per year). The best model (area under the receiver operating characteristic curve [AUC]: 0.80 [95% CI: 0.74, 0.83]; Brier score: 0.08) to predict MACE in female individuals included the following variables: age older than 69 years (hazard ratio [HR]: 1.58, P = .01), diabetes mellitus (HR: 1.47, P = .03), pharmacologic test (HR: 1.63, P = .01), ST-segment depression (≥1 mm) (HR: 2.02, P < .001), myocardial ischemia greater than 5% (HR: 2.21, P < .001), perfusion defect at rest greater than 9% (HR: 1.96, P = .009), perfusion defect at stress greater than 6% (HR: 1.63, P = .03), and end-systolic volume index greater than 15 mL (HR: 2.04, P < .001). During validation, the model achieved moderate performance (AUC: 0.78 [95% CI: 0.70, 0.83]). CORSWO obtained from these variables allowed for stratification of female individuals into four risk levels: low (score: 0-3, HR: 1), moderate (score: 4-6, HR: 1.58), high (score: 7-11, HR: 4.13), and very high (score: >11, HR: 13.87). The high and very high risk levels (HR: 5.29) predicted MACE in female individuals, with excellent performance (AUC: 0.78 [95% CI: 0.72, 0.80]). Conclusion With clinical, stress test, and gSPECT MPI variables, CORSWO effectively stratified female individuals according to coronary risk and was able to detect those with high and very high risk. Keywords: SPECT, Cardiac, Coronary Arteries, Women, Risk Stratification, Cardiac Event, CORSWO, MACE, Gated SPECT Supplemental material is available for this article. ©RSNA, 2024.

Prognostic significance of previous myocardial infarction and previous revascularization in patients undergoing SPECT MPI

BACKGROUND

Accurate risk stratification in patients with known coronary artery disease (CAD) is critical for patient management. Prior myocardial infarction (MI) or revascularization without MI are often equated as known CAD. We compared the prognostic significance of prior MI and previous revascularization in patients undergoing single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).

METHODS

Consecutive patients undergoing SPECT MPI at Cedars-Sinai Medical Center between 1992 and 2012 were included. Medical history, including history of MI or revascularization, was collected prospectively. Association with all-cause mortality was assessed with multivariable Cox analysis, adjusted for patient demographics, medical history, medications, and SPECT MPI results.

RESULTS

In total, 50,121 patients were identified including 7428 (14.8%) with a history of previous MI and 3608 (7.2%) with a history of revascularization without prior MI. During a median follow-up of 8.0 years, 19,696 (39.3%) patients died including 4467 (60.1%) with a history of MI and 1880 (52.1%) with a history of revascularization. Prior MI (adjusted HR 1.12, p=0.001) and prior revascularization without MI (adjusted HR 1.15, p<0.001) were independently associated with increased all-cause mortality. Previous MI (adjusted HR 1.27, p<0.001) and previous revascularization without MI (adjusted HR 1.21, p<0.001) were significantly associated with increased all-cause mortality only in patients without ischemia.

CONCLUSIONS

In this large cohort of patients undergoing SPECT MPI, previous MI and previous revascularization without MI were independent predictors of all-cause mortality, with no significant difference in associated risk. History of CAD may be particularly important for risk stratification in patients without ischemia.

Association of coronary artery calcium with bone mineral density in postmenopausal women

OBJECTIVES

Atherosclerosis and osteoporosis (OP) are common diseases in elderly individuals and may share common pathogenetic mechanisms. The aim of this study was to investigate the association between bone mineral density (BMD) and coronary artery calcium (CAC) in postmenopausal women.

METHODS

In this cross-sectional study, 186 postmenopausal women 50-80 years of age were included. BMD of the spine and femoral neck was measured by dual-energy X-ray absorptiometry. The coronary artery calcium score (CACS) was measured by multidetector computed tomography.

RESULTS

The study included postmenopausal women aged 65.6±7.3 years, 109 of whom (58.6%) showed CAC. Thirty-three (17.7%) of the patients were found to have OP in the lumbar spine and 83 (44.6%) had osteopenia, whereas in the femoral neck, 26 patients (14.0%) had OP and 87 patients (46.8%) had osteopenia. The mean CACS was 57.6±108.3 in normal status, 89.7±143.5 in OP, and 156.4±256.9 in osteopenia at the spine (P<0.05). The mean CACS was 43.2±89.9 in normal status, 126.9±180.3 in OP, and 198.2±301.2 in osteopenia at the femoral neck (P<0.05). Multivariable logistic regression analysis showed that BMD was an independent marker for an increased risk of developing CAC in postmenopausal women. The multiple regression model showed that T-scores were the independent predictors of CACS.

CONCLUSION

BMD identified on images from dual-energy X-ray absorptiometry were strongly related to multidetector computed tomography measures of CAC. This low-cost, minimal radiation technique used widely for OP screening is a promising marker of generalized coronary atherosclerosis.