PURPOSE: Myocardial perfusion imaging (MPI) has limitations in the presence of @entity66 ( @entity66 ) and left main (LM) @entity453 , occasionally resulting in false-normal results despite the high cardiovascular risk associated with this condition. The purpose of this study was to assess the incidence of severe @entity453 ( @entity453 ) in the presence of a very high Agatston coronary artery @entity460 (CAC) score (>1,000) in stable symptomatic @entity1 without known @entity453 but with normal MPI results. METHODS: A total of 2,659 prospectively acquired consecutive @entity1 were referred for MPI and evaluation of CAC score by CT. Of this @entity1 population, 8  % (222/2,659) had @entity63 without @entity583 ( @entity583 ) on MPIand 11  % (298/2,659) had abnormal MPI ( @entity583 and/or @entity63 ). On presentation 1  % of the @entity1 (26/2,659) were symptomatic, had a CAC score >1,000 and normal MPI results. The definition of normal MPI was strict and included a normal hemodynamic response without ischemic ECG changes and normal imaging, particularly absence of transient @entity384 . All of these 26 @entity1 with a CAC score >1,000 and normal MPI findings underwent cardiac catheterization. RESULTS: Of these 26 @entity1 , 58  % (15/26) had severe disease (>= 70  % stenosis) leading to revascularization. Of this group, 47  % (7/15) underwent percutaneous intervention, and 53  % (8/15) underwent coronary artery bypass grafting. All of these 15 @entity1 had either @entity66 (14/15) or LM @entity453 (1/15), and represented 0.6  % (15/2,659) of all referred @entity1 (95  % CI 0.3  -  0.9  %). The majority, 90  % (8/9), had severe @entity453 with typical @entity662 . CONCLUSION: A very high CAC score (>1,000) with normal MPI in a small subset of symptomatically stable @entity1 was associated with a moderate incidence of severe @entity453 (95  % CI 37  -  77  %). Larger studies and/or a meta-analysis of small studies are needed to more precisely estimate the incidence of @entity453 in this population. This study also supports the concept that a normal MPI result in @entity1 with severe @entity453 may be due to balanced @entity66 .

Very high coronary artery XXXX score with normal myocardial perfusion SPECT imaging is associated with a moderate incidence of severe @entity453 .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity662 :: ('MESH:D002637', 'Disease') :: ['chest pain'] @entity66 :: ('MESH:D004194', 'Disease') :: ['balanced multivessel disease', 'MVD'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction', 'MI'] @entity63 :: ('MESH:D007511', 'Disease') :: ['ischemia'] @entity384 :: ('MESH:D002311', 'Disease') :: ['ischemic dilation'] @entity460 :: ('MESH:D002118', 'Chemical') :: ['calcium'] @entity453 :: ('MESH:D003324', 'Disease') :: ['CAD', 'coronary artery disease']
@entity460 :: (MESH:D002118,Chemical) :: ['calcium']
