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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Incidence and Implication of Coronary Artery Calcium on Non-gated Chest Computed Tomography Scans: A Large
Charles Haller1, Anthony Vandehei1, Raymond Fisher1
1Cardiology, Brooke Army Medical Center, Fort Sam Houston, USA.
Insights
Coronary artery calcification (CAC) detected on non-gated chest CT scans can identify patients at higher risk for myocardial infarction (MI) and revascularization. This finding is crucial given the increasing use of CT for lung cancer screening.
Area of Science:
- Cardiology
- Radiology
- Public Health
Background:
- Coronary artery calcification (CAC) scoring typically uses electrocardiogram- (ECG) gated, non-contrast CT for cardiovascular (CV) risk assessment.
- Coronary calcification can also be identified on non-gated chest CT scans, relevant for lung cancer screening protocols.
- Traditional cardiac risk factors are often insufficient for comprehensive CV risk stratification.
Purpose of the Study:
- To evaluate the association between coronary artery calcification (CAC) detected on non-gated chest CT scans and cardiovascular outcomes.
- To determine if CAC on non-gated CT can serve as an independent predictor of major adverse cardiac events (MACE).
Main Methods:
- Retrospective review of 4,953 non-contrast chest CT scans performed over 18 months.
- Abstraction of baseline cardiovascular outcomes (MI, CVA, revascularization, death, MACE) and risk factors from electronic medical records.
- Statistical analysis to compare outcomes between patients with and without CAC, including adjusted odds ratios.
Main Results:
- Coronary artery calcification (CAC) was present in 63% of patients; these patients had more traditional CV risk factors.
- Unadjusted analysis showed significantly higher odds of MACE, death, MI, revascularization, and CVA in patients with CAC.
- After adjusting for baseline risk factors, CAC on non-gated CT remained significantly associated with increased odds of MI and revascularization.
Conclusions:
- Findings of CAC on non-gated chest CT can help identify patients at increased risk for myocardial infarction (MI) and revascularization.
- Reporting incidental CAC findings on non-gated chest CTs, especially those for lung cancer screening, can improve patient risk stratification.
- This approach may enhance early detection and management of cardiovascular disease in asymptomatic individuals.
Abstract:
Introduction Coronary artery calcification (CAC) scoring is typically performed utilizing non-contrast, electrocardiogram- (ECG) gated CT and offers an estimation of cardiovascular (CV) prognosis and risk stratification beyond previously established cardiac risk factors. Coronary calcification can also be assessed during non-gated chest CT, which is significant given the recent recommendations for lung cancer screening by low-dose CT. Methods We retrospectively reviewed 4,953 non-contrast chest CT scans in a single, closed referral tertiary military treatment facility over an 18-month period. Baseline CV outcomes to include myocardial infarction (MI), cerebral vascular accidents (CVA), revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), death, or a composite of all major adverse cardiac events (MACE), and baseline CV risk factors were abstracted from an electronic medical record (EMR) review. Results CAC was seen in 3,119 (63%) patients while 1,834 (27%) were without CAC. All traditional CV risk factors were more commonly observed in patients with CAC. Unadjusted odds of composite MACE, death, MI, coronary revascularization, and CVA between presence and absence of CAC were as follows: 3.55 [95% confidence interval (CI): 2.60-4.86, p: <0.0001]; 2.98 (95% CI: 2.02-4.40, p: <0.0001); 24.42 (95% CI: 3.36-177.6, p: <0.0001); 5.64 (95% CI: 2.58-12.32, p: <0.0001); and 2.32 (95% CI: 1.19-4.50, p: 0.0104), respectively. However, after adjusting for baseline risk factors, CAC on non-gated CT was associated only with an increased observed rate of MI (aOR: 38.1, 95% CI: 4.57-318.2, p: <0.0001) and revascularization (aOR: 5.58, 95% CI: 2.22-14.0, p; 0.0003). Conclusions Findings of CAC on non-gated chest CT may help to recognize patients who are at increased risk of MI and revascularization. Given the expected increase in chest CT utilization among former smokers for lung cancer screening, observed CAC should be reported to ordering providers in order to identify patients at increased risk of these important outcomes.
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