Rozanski A, Gransar H, Miller RJH, et al. - This study was undertaken to evaluate the correlation between coronary artery calcium (CAC) scores and mortality risk among patients undergoing exercise versus pharmacologic SPECT myocardial perfusion imaging (MPI) to evaluate whether elevated atherosclerotic burden accounts for this increased risk. All-cause mortality was evaluated in 2,151 individuals, followed for 12.2 +3.4 years, after undergoing stress-rest SPECT-MPI and CAC scanning within 3 months of each other. Individuals were classified according to their mode of stress testing (exercise or pharmacologic). They further used propensity analysis to develop a subgroup of exercise and pharmacologic subgroups with comparable age, symptoms, and coronary risk factors. This study's findings indicate that pharmacologic patients have substantially elevated mortality risk in comparison with exercise patients among individuals referred for stress-rest SPECT-MPI and CAC scoring, despite having comparable levels of coronary atherosclerosis.