Original StudiesEffect of Elevated Calcium Score on Normal Myocardial Perfusion Study on Clinician Management of Coronary Artery Disease Risk FactorsWokhlu, Anita MD*,†; Wymer, David MD*; Taasan, Vicente MD*; Winchester, David E. MD*,†Author Information From the *Malcom Randall VAMC, Gainesville, FL †University of Florida College of Medicine, Division of Cardiovascular Medicine, Gainesville, FL. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. Government. Reprints: David E. Winchester, MD, MS, Malcom Randall VAMC, University of Florida College of Medicine, Division of Cardiovascular Medicine, 1601 SW Archer Road, 111-D, Gainesville, FL 32608. E-mail: firstname.lastname@example.org. Critical Pathways in Cardiology: June 2020 - Volume 19 - Issue 2 - p 58-61 doi: 10.1097/HPC.0000000000000209 Buy Metrics Abstract Elevated coronary artery calcification (CAC) scores are associated with higher cardiovascular (CV) risk even with normal stress myocardial perfusion imaging (MPI). Whether referring providers appropriately manage subclinical CV disease is unclear. We hypothesized that ordering clinicians would intensify medical therapy for CV disease in response to normal MPI and CAC ≥ 300. We conducted a cohort study on patients without known CV disease who underwent MPI and CAC scoring. Medical management of CV disease and clinical outcomes were assessed. Of 299 patients who underwent stress MPI, 62 patients had normal MPI and CAC ≥ 300. Documentation of elevated CAC score was noted in the final interpretation for 52% (n = 32) of MPI reports. During follow-up, treatment change in aspirin, cholesterol medications, and/or antihypertensive medication was made in 40% of these patients. Aspirin use increased from 71% to 82% (P < 0.001); statin use increased from 68% to 76% (P < 0.001). Several patients remained on suboptimal lipid or antiplatelet regimens without documented contraindication. Among patients with normal MPI, many have CAC ≥ 300. Not all MPI reports adequately call attention to this finding associated with elevated CV risk. Despite the elevated CAC score, some patients were not optimized medically. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.