{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T23:19:59Z","timestamp":1787786399801,"version":"build-2784847793"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The prognostic value of coronary artery calcium (CAC) scoring on top of myocardial perfusion imaging with single-photon emission computed tomography (SPECT) in patients suspected for coronary artery disease is not well established.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Four thousand eight hundred ninety-seven symptomatic patients without a history of coronary artery disease referred for SPECT and CAC scoring were included. Major adverse cardiac events (MACEs) were defined as late revascularization (&gt;90 days after scanning), nonfatal myocardial infarction, and all-cause mortality. The frequency of abnormal SPECT increased with higher CAC scores, from 12% in patients with CAC scores of 0 to 19%, 32%, 37%, and 50% among those with CAC scores 1 to 99, 100 to 399, 400 to 999, and \u22651000, respectively (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). During a median follow-up of 940 days (25th to 75th percentile, 581\u20131377), a total of 278 MACEs were observed. Overall incidence of MACE was 2.3% per year. A stepwise increase of MACE was present with increasing CAC scores, both in patients with normal SPECT (annual event rate CAC score 0: 0.6%; CAC score \u22651000: 5.5%) and abnormal SPECT (annual event rate CAC score 0: 0.4%; CAC score \u22651000: 7.6%). After multivariate analysis, both SPECT and CAC score were independent predictors of MACE (CAC score \u22651000: hazard ratio, 7.7;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001 and large perfusion defect on SPECT: hazard ratio, 3.7;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>CAC score and SPECT are independent predictors of MACE in patients suspected for coronary artery disease. Our findings strongly support performing a CAC score in addition to SPECT in symptomatic patients to better define the risk of events during follow-up.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.115.003966","type":"journal-article","created":{"date-parts":[[2016,5,11]],"date-time":"2016-05-11T05:56:10Z","timestamp":1462946170000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":102,"title":["Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients"],"prefix":"10.1161","volume":"9","author":[{"given":"Elsemiek M.","family":"Engbers","sequence":"first","affiliation":[{"name":"From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorik R.","family":"Timmer","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Paul","family":"Ottervanger","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Mouden","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siert","family":"Knollema","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology 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