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Qualitative coronary artery calcium assessment on CT lung screening exam helps predict first cardiac events

Katherine B Malcolm1,2, Danya L Dinwoodey1, Michael C Cundiff1

  • 1Department of Radiation Oncology, Radiology, Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA.

Journal of Thoracic Disease
|July 13, 2018
PubMed

Insights

Coronary artery calcification (CAC) scoring from CT lung screening (CTLS) identifies individuals at higher risk for cardiac events. Higher CAC scores correlate with increased odds of experiencing a cardiac event, aiding in risk stratification.

Area of Science:

  • Cardiology
  • Radiology
  • Preventive Medicine

Background:

  • Coronary artery calcification (CAC) is a marker of atherosclerosis.
  • Current risk prediction models may not fully capture individual cardiac event risk.

Purpose of the Study:

  • To evaluate the utility of qualitative coronary artery calcification (CAC) scoring from computed tomography lung screening (CTLS) exams.
  • To determine if CAC scoring can aid in selecting individuals at elevated risk for initial cardiac events.

Main Methods:

  • A cohort of 1,513 individuals undergoing CTLS was analyzed.
  • CAC scores were categorized qualitatively (none, mild, moderate, marked).
  • Cardiac events and time to event were assessed over a mean follow-up of 2.64 years using multivariable logistic and time to event analyses.

Main Results:

  • A total of 43 cardiac events occurred.
  • Event rates increased with CAC severity: 1.55% (mild), 3.24% (moderate), and 8.90% (marked), versus 0% (none).
  • Odds of an initial cardiac event significantly increased with CAC severity compared to no CAC (mild: 2.56x, moderate: 6.57x, marked: 16.8x).

Conclusions:

  • Qualitative CAC scoring of CTLS exams is a novel method for identifying individuals at elevated risk for initial cardiac events.
  • CAC scoring can enhance cardiovascular risk stratification beyond traditional risk factors.
Abstract

Keywords:
2012 through August 262014 with follow-up through December 312015 were retrospectively reviewed. Correlations were assessed through multivariable logistic regression modeling and time to event analysisBackground: Qualitative assessment of coronary artery calcium (CAC) burden on CT lung screening (CTLS) exams offers an opportunity to improve cardiac risk stratification among millions of current and former heavy smokers at no additional cost or radiation exposure.Coronary artery disease (CAD)Methods: Qualitative CAC scores and subsequent myocardial infarction or revascularization (cardiac events) among individuals undergoing CTLS at our institution from January 1cancer screeninglung cancermulti-detector computed tomographymyocardial infarction

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