PT  - JOURNAL ARTICLE
AU  - Senthil Selvaraj
AU  - Muhammad Shoaib Khan
AU  - Mahesh K Vidula
AU  - Philip C Wiener
AU  - Alejandro E de Feria
AU  - Chaitanya Rojulpote
AU  - Sheela Krishnan
AU  - Ruth Tamrat
AU  - Howard Julien
AU  - Douglas Jacoby
AU  - Harold Litt
AU  - Daniel Pryma
AU  - Jacob Dubroff
AU  - Marie A Guerraty
AU  - Paco Bravo
TI  - Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging
AID  - 10.1136/openhrt-2021-001648
DP  - 2021 May 01
TA  - Open Heart
PG  - e001648
VI  - 8
IP  - 1
4099  - http://openheart.bmj.com/content/8/1/e001648.short
4100  - http://openheart.bmj.com/content/8/1/e001648.full
SO  - Open Heart2021 May 01; 8
AB  - 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.Data are available on reasonable request.