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Updated: Jan 5, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a
M C Williams1, N C D Morley2, K C Muir3
1BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK.
Insights
Coronary artery calcification (CAC) predicts mortality in pulmonary embolism (PE) patients. Assessing CAC in PE cases can guide patient management and improve outcomes.
Area of Science:
- Cardiology
- Radiology
- Pulmonology
Background:
- Pulmonary embolism (PE) is a significant cause of mortality.
- Coronary artery calcification (CAC) is a marker of atherosclerosis.
- The relationship between CAC and mortality in PE patients requires further investigation.
Purpose of the Study:
- To evaluate the presence and severity of CAC in patients diagnosed with PE.
- To determine if CAC correlates with vascular calcification and overall mortality in PE patients.
- To assess the predictive value of CAC for 3-year all-cause mortality in PE.
Main Methods:
- 400 consecutive PE patients underwent CTPA to assess PE severity (modified Miller score) and RV/LV ratio.
- Coronary artery calcification score (CACS) was calculated using a four-point scale for each coronary artery.
- Mortality data was collected over a 3-year follow-up period.
Main Results:
- 32% of PE patients experienced all-cause mortality within 3 years.
- Patients with CAC were three times more likely to die compared to those without CAC (HR 2.96).
- Severe CAC significantly increased mortality risk (HR 4.62), and CACS, along with age, independently predicted 3-year mortality.
Conclusions:
- Coronary artery calcification score (CACS) is an independent predictor of all-cause mortality in patients with pulmonary embolism.
- The findings suggest that CAC assessment in PE patients has significant implications for risk stratification and patient management.
- Further research may explore the underlying mechanisms linking CAC and PE outcomes.
Aim:
To assess coronary artery calcification (CAC) and vascular calcification in patients with pulmonary embolism (PE) and correlate this with mortality.
Materials And Methods:
PE severity was quantified using computed tomography pulmonary angiography (CTPA) in 400 consecutive cases using the modified Miller score (1-5, mild; 6-11, moderate; 12-16, severe). Right ventricle strain was assessed using the right/left ventricle diameter (RV/LV) ratio. CAC score (CACS) was assessed using a four-point scale (CACS mild 1-3, moderate 4-8, severe 9-12) for each vessel and summed to give the total CACS. Follow-up for mortality was obtained at 3 years.
Results:
PE severity was classified as mild in 48%, moderate in 21%, and severe in 32% of cases. The median modified Miller score was 6 (Interquartile range [IQR] 2, 14) and median total CACS was 2 (IQR 0, 7). All-cause mortality occurred in 128 (32%) patients. Patients with CAC were three times more likely to die than patients without CAC (Hazard ratio [HR] 2.96; 95% CI 1.84, 4.77; p<0.001), and patients with severe CAC were at the highest risk (HR 4.62; 95% CI 2.73, 7.83, p<0.001). Gender, modified Miller score and RV/LV ratio were not predictive of mortality. In multivariate analysis both CACS and age were independent predictors of 3-year all-cause mortality. Of the patients with CAC who died, the presence of coronary artery disease was only documented in 34 (32%).
Conclusion:
CACS is an independent predictor of all-cause mortality in patients with PE, and has important implications for subsequent patient management.
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