Unrequested information from routine diagnostic chest CT predicts future cardiovascular events

Area of Science:

• Cardiology
• Radiology
• Preventive Medicine

Background:

• Routine diagnostic chest CT scans can reveal incidental findings like coronary artery calcification (CAC) and aortic calcification (TAC).
• The clinical significance of these subclinical calcifications, often unrequested, remains largely unknown.
• This study addresses the prognostic relevance of incidental CAC and TAC in a real-world clinical setting.

Purpose of the Study:

• To investigate the prognostic value of subclinical coronary artery calcification (CAC) and aortic calcification (TAC) identified on routine diagnostic chest CT scans.
• To determine if these incidental findings predict future cardiovascular disease (CVD) events in a general clinical care population.
• To establish the independent predictive power of CAC and TAC for incident CVD.

Main Methods:

• A multicentre cohort study included 10,410 subjects over 40 years old without a history of CVD.
• Coronary calcification (CAC score 0-12) and aortic calcification (TAC score 0-8) were semi-quantitatively assessed from routine chest CTs.
• Cox proportional-hazard models were used to analyze the association between calcification scores and 240 fatal or 275 non-fatal CVD events over a mean follow-up of 17.8 months.

Main Results:

• Both CAC and TAC were significant and independent predictors of incident cardiovascular disease (CVD) events.
• Patients with severe coronary calcification (CAC score ≥6) had a 3.7 times higher risk of CVD events compared to those with no calcification.
• Patients with severe aortic calcification (TAC score ≥5) had a 2.7 times higher risk of CVD events compared to those with no calcification.

Conclusions:

• Subclinical vascular calcification, including coronary and aortic, detected on routine CT scans is a strong predictor of future cardiovascular events.
• Incidental findings of CAC and TAC on chest CTs hold significant prognostic value in a routine clinical care population.
• These findings underscore the importance of reporting and considering incidental vascular calcifications for cardiovascular risk assessment.