BACKGROUND Myocardial perfusion imaging, including positron emission tomography/computed tomography (PET/CT), is often used to assess for high-grade coronary artery disease (CAD) requiring revascularization. The use of coronary artery calcium (CAC) to predict risk of major adverse cardiovascular events in asymptomatic patients is accepted. However, little is known regarding the use of CAC in PET/CT patients without known CAD in identifying patients unlikely to need revascularization. Here, we determined whether the absence of CAC, using low-dose attenuation correction CT obtained during the PET/CT, identifies patients unlikely to undergo coronary revascularization within 90 days of a PET/CT. METHODS Patients, without a history of CAD and no elevation in troponin, referred for PET/CT at Intermountain Medical Center were studied (n=5528). The presence of CAC was visually assessed using low-dose attenuation correction CT. The association between CAC and 90-day high-grade CAD and revascularization were assessed. Longer-term (up to 4 years) major adverse cardiovascular events, including all-cause death, myocardial infarction, and late revascularization (>90 days), were examined. RESULTS There were 2510 (45.4%) patients in CAC-present group and 3018 (54.6%) patients in CAC-absent group. The CAC-absent group, compared with the CAC-present group, was less likely to undergo coronary angiography (3.4% versus 10.2%, P<0.0001), have high-grade CAD (0.5% versus 6.5%, P<0.0001), and receive revascularization (0.4% versus 5.8%, [adjusted odds ratio =0.09; 95% CI, 0.05-0.16]; P<0.0001). In patients with an ischemic burden >10%, the CAC-absent group was associated with reduced revascularization (P<0.0001). Longer-term major adverse cardiovascular events were lower in the CAC-absent (2.4%) compared with the CAC-present (6.9%) group (adjusted hazard ratio, 0.45 [95% CI, 0.34-0.60]; P<0.0001). CONCLUSIONS The absence of CAC on low-dose attenuation correction CT identifies PET/CT patients unlikely to have high-grade CAD or require revascularization within 90 days and unlikely to experience longer-term major adverse cardiovascular events. The prognostic value of CAC, beyond ischemic burden, suggests its potential as a first-step screening tool in intermediate-risk patients to identify those who do not need coronary revascularization.

中文翻译：

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在没有已知冠状动脉疾病的患者中，在正电子发射断层扫描压力测试期间不存在冠状动脉钙，可以识别出心脏事件风险非常低的个体。

背景技术包括正电子发射断层摄影术/计算机断层摄影术（PET / CT）在内的心肌灌注成像经常被用于评估需要血管重建的高级冠状动脉疾病（CAD）。接受使用冠状动脉钙（CAC）预测无症状患者发生重大不良心血管事件的风险。然而，对于在没有已知CAD的PET / CT患者中使用CAC来确定不太可能需要血管重建的患者的了解很少。在这里，我们使用在PET / CT期间获得的低剂量衰减校正CT来确定是否不存在CAC，从而确定不太可能在PET / CT的90天内进行冠状动脉血运重建的患者。方法对无山间神经节病史，肌钙蛋白无升高，在山间医学中心接受PET / CT检查的患者进行了研究（n = 5528）。使用低剂量衰减校正CT视觉评估CAC的存在。评估了CAC与90天高级CAD和血运重建之间的关联。检查了长期（最多4年）的主要不良心血管事件，包括全因死亡，心肌梗塞和晚期血运重建（> 90天）。结果CAC存在组有2510例（45.4％）患者，而CAC缺失组有3018例（54.6％）患者。与存在CAC的组相比，缺少CAC的组进行冠状动脉造影的可能性较小（3.4％对10.2％，P <0.0001），具有较高级别的CAD（0.5％对6.5％，P <0.0001），并接受血运重建（0.4％比5.8％，[调整后的优势比= 0.09； 95％CI，0.05-0.16]； P <0.0001）。在缺血负荷> 10％的患者中，CAC缺席组与血运重建减少相关（P <0.0001）。缺乏CAC的长期重大心血管不良事件（2.4％）低于存在CAC的组（6.9％）（调整后的危险比为0.45 [95％CI，0.34-0.60]； P <0.0001）。结论小剂量衰减校正CT上不存在CAC，可以确定PET / CT患者不太可能患有高级别的CAD或90天内需要进行血运重建，并且不太可能经历长期的重大心血管不良事件。除了缺血性负担外，CAC的预后价值还表明它具有作为中度风险患者识别不需要冠脉血运重建者的第一步筛查工具的潜力。与出现CAC的组（6.9％）相比（调整后的危险比为0.45 [95％CI，0.34-0.60]； P <0.0001）。结论小剂量衰减校正CT上没有CAC可以确定PET / CT患者不太可能患有高级别的CAD或90天内需要重新血管化，并且不太可能经历长期的重大不良心血管事件。除了缺血性负担外，CAC的预后价值还表明它具有作为中度风险患者识别不需要冠脉血运重建者的第一步筛查工具的潜力。与出现CAC的组（6.9％）相比（调整后的危险比为0.45 [95％CI，0.34-0.60]； P <0.0001）。结论小剂量衰减校正CT上没有CAC可以确定PET / CT患者不太可能患有高级别的CAD或90天内需要重新血管化，并且不太可能经历长期的重大不良心血管事件。除了缺血性负担外，CAC的预后价值还表明它具有作为中度风险患者识别不需要冠脉血运重建者的第一步筛查工具的潜力。结论小剂量衰减校正CT上没有CAC可以确定PET / CT患者不太可能患有高级别的CAD或90天内需要重新血管化，并且不太可能经历长期的重大不良心血管事件。除了缺血性负担外，CAC的预后价值还表明它具有作为中度风险患者识别不需要冠脉血运重建者的第一步筛查工具的潜力。结论小剂量衰减校正CT上没有CAC可以确定PET / CT患者不太可能患有高级别的CAD或90天内需要重新血管化，并且不太可能经历长期的重大不良心血管事件。除了缺血性负担外，CAC的预后价值还表明它具有作为中度风险患者识别不需要冠脉血运重建者的第一步筛查工具的潜力。