J Cardiovasc Comput Tomogr. 2026 Aug 26:S1934-5925(26)00459-4. doi: 10.1016/j.jcct.2026.07.011. Online ahead of print.
ABSTRACT
BACKGROUND: The coronary artery calcium score (CACS) has strong prognostic value in stable chest pain patients. However, studies with follow-up beyond 5 years are scarce. We studied the long-term prognosis of CACS beyond pre-test probability (PTP) and single-photon emission computed tomography (SPECT) results for major adverse cardiac events (MACE).
METHODS: We performed a retrospective cohort study among 6059 patients with non-acute chest pain, suspected of obstructive coronary artery disease who underwent clinically indicated SPECT/CT imaging with simultaneous CACS. Data on MACE, defined as cardiac death and non-fatal myocardial infarction, were collected during follow-up. The value of CACS in addition to PTP categories and SPECT results was studied using multivariable Cox analysis.
RESULTS: During a median follow-up of 9.1 years (IQR 7.8-10.4), 6.1% (N = 365) of patients suffered from MACE. In CACS 0 (27% of all) annual MACE rates were 0.2-0.3% across PTP categories, and 0.2-0.6% across SPECT results. In CACS >1000 (10 % of all) annual MACE rates were 2.5-2.5% across PTP categories and 2.2-3.0% across SPECT results. High CACS (>1000 vs. 0, HR 4.14; 95%CI, 2.64-6.53) and abnormal SPECT (>10% ischemia vs. normal, HR 1.78; 95%CI, 1.27-2.46) predicted MACE. Compared to a model of PTP and cardiovascular risk factors (area under the ROC curve 0.72), adding SPECT improved discriminatory ability (0.73; p = 0.003), and adding CACS on top of SPECT improved performance further (0.75; p < 0.001).
CONCLUSIONS: CACS adds incremental prognostic information to PTP and SPECT in stable chest pain patients. Absence of coronary calcium results in an excellent long-term prognosis regardless of PTP and SPECT result.
PMID:42648974 | DOI:10.1016/j.jcct.2026.07.011