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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Relationship of Coronary Calcium on Standard Chest CT Scans With Mortality
Jan M Hughes-Austin1, Arturo Dominguez2, Matthew A Allison3
1Department of Orthopaedic Surgery, School of Medicine, University of California, San Diego, California; Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, California.
Insights
Coronary artery calcium (CAC) scores from standard 6 mm chest CT scans strongly correlate with those from 3 mm ECG-gated CT scans. Both scan types effectively predict mortality risk in community-living individuals.
Area of Science:
- Radiology and Imaging Science
- Cardiovascular Disease Research
- Medical Diagnostics
Background:
- Coronary artery calcification (CAC) is a key predictor of cardiovascular disease (CVD) and mortality.
- CAC is typically quantified using 3 mm ECG-gated CT scans.
- Standard 6 mm chest CT scans are more common but not routinely used for CAC quantification.
Purpose of the Study:
- To determine the correlation between CAC scores from 3 mm ECG-gated CT and 6 mm standard chest CT scans.
- To compare the predictive strength of CAC on both scan types for mortality risk.
Main Methods:
- A nested case-control study of 4,544 individuals who underwent both 3 mm ECG-gated and 6 mm standard chest CT scans.
- CAC was quantified using the Agatston method on both scan types.
- Unconditional logistic regression analyzed associations between CAC scores and mortality, adjusting for CVD risk factors.
Main Results:
- A strong Spearman correlation (0.93) was found between CAC scores from the two scan types.
- Median CAC scores were lower on 6 mm CTs (22 AU) compared to 3 mm CTs (104 AU).
- Higher CAC scores on 6 mm CTs were associated with a 50% increased odds of death, similar to 3 mm ECG-gated CTs.
Conclusions:
- Standard 6 mm chest CT scans demonstrate strong correlation with 3 mm ECG-gated CT scans for CAC scoring.
- CAC scores from standard chest CTs effectively predict mortality risk in community-living individuals.
- Standard chest CTs represent an underutilized resource for assessing CVD risk without additional radiation or cost.
Objectives:
The aim of this study was to determine the correlation between coronary artery calcium (CAC) scores on 3 mm electrocardiography (ECG)-gated computed tomography (CT) scans and standard 6 mm chest CT scans, and to compare relative strength of associations of CAC on each scan type with mortality risk.
Background:
Coronary artery calcification predicts cardiovascular disease (CVD) and all-cause mortality, and is typically measured on ECG-gated 3 mm CT scans. Patients undergo standard 6 mm chest CTs for various clinical indications much more frequently, but CAC is not usually quantified. To better understand the usefulness of standard chest CTs to quantify CAC, we conducted a case-control study among persons who had both scan types.
Methods:
Between 2000 and 2003, 4,544 community-living individuals self- or physician-referred for "whole-body" CT scans, had 3 mm ECG-gated CTs and standard 6 mm chest CTs, and were followed for mortality through 2009. In this nested case-control study, we identified 157 deaths and 494 controls frequency matched (1:3) on age and sex. The Agatston method quantified CAC on both scan types. Unconditional logistic regression determined associations with mortality, accounting for CVD risk factors.
Results:
Participants were 68 ± 11 years of age and 63% male. The Spearman correlation of CAC scores between the 2 scan types was 0.93 (p < 0.001); median CAC scores were lower on 6 mm CTs compared to 3 mm CTs (22 vs.104 Agatston units, p < 0.001). Adjusted for traditional CVD risk factors, each standard deviation higher CAC score on 6 mm CTs was associated with 50% higher odds of death (odds ratio: 1.5; 95% confidence interval: 1.2 to 1.9), similar to 50% higher odds on the 3 mm ECG-gated CTs (odds ratio: 1.5; 95% confidence interval: 1.1 to 1.9).
Conclusions:
CAC scores on standard 6 mm chest CTs are strongly correlated with 3 mm ECG-gated CTs and similarly predict mortality in community-living individuals. Chest CTs performed for other clinical indications may provide an untapped resource to garner CVD risk information without additional radiation exposure or expense.
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