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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcification predicts cardiovascular complications after sepsis
Vedant A Gupta1, Matthew Sousa2, Nathan Kraitman2
1Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, 1000 S. Limestone, Lexington, KY 40536, USA.
Insights
Coronary artery calcification (CAC) identified on CT scans effectively stratifies cardiovascular risk in sepsis patients. This finding improves upon traditional risk factors, aiding personalized patient management.
Area of Science:
- Cardiology
- Critical Care Medicine
- Radiology
Background:
- Sepsis presents a high risk of cardiovascular events (25-30% at 1 year), yet effective risk stratification remains limited.
- Accurate assessment of cardiovascular risk in septic patients is crucial for timely and appropriate management.
Purpose of the Study:
- To evaluate the utility of coronary artery calcification (CAC) in stratifying cardiovascular risk in patients with sepsis.
- To determine if CAC, identifiable on routine body CT scans, can predict adverse cardiovascular outcomes in septic individuals.
Main Methods:
- A cohort of 267 septic patients with detectable troponin and available CT scans was analyzed, excluding those with recent cardiac interventions.
- Coronary artery calcification (CAC) presence was assessed from body CT scans.
- Multivariate logistic regression was used to assess the association between CAC and a composite outcome of cardiovascular death, acute myocardial infarction, or PCI at 1 year.
Main Results:
- Patients with CAC were older, more likely male, and had more coronary disease risk factors, but similar troponin levels and APACHE II scores compared to those without CAC.
- CAC was a significant independent predictor of 1-year adverse cardiovascular outcomes (OR 6.827; p=0.037).
- Septic patients without CAC, a history of congestive heart failure (CHF), or chronic kidney disease (CKD) exhibited a very low risk (<1%) of cardiovascular complications at 1 year, even with elevated troponin levels.
Conclusions:
- Coronary artery calcification (CAC) is a superior risk stratification tool for cardiovascular complications in sepsis compared to traditional risk factors.
- CAC can be readily identified on body CT scans, offering a practical approach for risk assessment.
- A novel risk stratification framework based on CAC can guide individualized management strategies for septic patients, potentially improving outcomes.
Purpose:
Sepsis is a highly prevalent and fatal condition, with reported cardiovascular event rates as high as 25-30% at 1year. Risk stratification in septic patients has been extremely limited.
Material And Methods:
267 septic patients with detectable troponin levels, APACHE II scores, and CT scans of the chest or abdomen were assessed. Patients with a recent cardiac intervention were excluded. Coronary artery calcification (CAC) was identified as present or absent on body CT scans. Cardiovascular death, acute myocardial infarction (AMI), or PCI at 1year was assessed using multivariate logistic regression analysis.
Results:
Patients with CAC were older, predominantly male with more risk factors for coronary disease, but similar peak troponin levels and APACHE II scores. In a multivariate analysis, CAC was predictive of the primary outcome (OR 6.827; 95% CI 1.336-54.686; p=0.037). Patients with no CAC, history of CHF or CKD were at low risk (<1%) for cardiovascular complications at 1year even at very high troponin levels (<8.0ng/dL).
Conclusion:
CAC risk stratifies septic patients for cardiovascular complications better than traditional risk factors and can be identified on body CT scans. This novel, risk stratifying framework built on CAC can help guide individualized management of septic patients.
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