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Coronary Artery Disease Association With Arterial Calcifications on Routine Hand Radiographs
Erin M Taylor1, Winona W Wu1, Qing Ruan1
1Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Insights
Arterial calcifications on hand X-rays are linked to coronary artery disease (CAD). This finding may help identify patients needing further cardiac investigation.
Area of Science:
- Cardiovascular Medicine
- Radiology
- Atherosclerosis Research
Background:
- Arterial calcifications in the lower extremities, chest, and cardiac vessels are known indicators of coronary artery disease (CAD).
- The association between arterial calcifications on hand and upper-extremity radiographs and atherosclerosis has not been well-established.
- Routine hand radiographs may offer a novel approach to assessing CAD risk.
Purpose of the Study:
- To investigate the relationship between arterial calcifications detected on hand radiographs and the presence of coronary artery disease (CAD).
- To determine if hand radiograph findings can serve as an indicator for underlying atherosclerosis.
Main Methods:
- A retrospective review of 345 patients with available hand radiographs and CAD screening data was conducted.
- Patients with specific comorbidities like chronic kidney disease were excluded.
- Arterial calcifications on hand X-rays were assessed, and CAD diagnosis was confirmed via cardiac stress testing or coronary angiography. Multivariable logistic regression was used for analysis.
Main Results:
- Out of 210 eligible patients, 155 had CAD and 55 did not.
- Arterial calcifications were present in 43% of patients with CAD versus 11% of those without CAD.
- Multivariable analysis revealed that arterial calcifications on hand films were independently associated with a 6.2-fold increased odds of having CAD, even after controlling for other risk factors.
Conclusions:
- Arterial calcifications observed on routine hand radiographs are significantly and independently associated with coronary artery disease (CAD).
- This association suggests that hand X-rays could be a valuable tool for identifying patients at risk for or with occult CAD.
- Physicians may utilize these findings as a prompt for further cardiac evaluation.
Purpose:
Arterial calcifications in the lower extremity, chest, and cardiac vessels have been linked to coronary artery disease (CAD). However, the relation between arterial calcifications observed on routine hand and upper-extremity radiographs and atherosclerosis has not been determined. This study examined whether arterial calcifications found on hand radiographs are associated with CAD.
Methods:
A record review from a single institution identified 345 patients with both hand radiographs and CAD screening with cardiac stress testing or coronary angiography. Patients with chronic kidney disease, end-stage renal disease, or incomplete hand films were excluded. We reviewed x-rays for findings of arterial calcifications. Cardiac testing results were used to establish a baseline diagnosis of CAD. We made group comparisons and employed multivariable logistic regression to evaluate the association between upper-extremity calcification and CAD.
Results:
A total of 210 patients met inclusion criteria: 155 with CAD and 55 without it. Mean age was 72 years, body mass index was 28.8, and 54% were male. Patients had comorbidities of hypertension (91%), hyperlipidemia (87%), diabetes (39%), cerebrovascular accident (9%), and a history of tobacco use (53%). Of 155 CAD patients, 67 had arterial calcifications on hand radiographs (43%), compared with 6 of 55 without it (11%). In a multivariable model controlling for sex, hyperlipidemia, and diabetes, the presence of arterial calcifications on hand plain films indicated a 6.2-fold increased odds of CAD.
Conclusions:
The current data demonstrate that arterial calcifications on hand radiographs are independently associated with CAD. This may represent an opportunity to the treating physician as a point of referral or investigation for underlying or occult CAD.
Type Of Study/Level Of Evidence:
Prevalence III.
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