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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Association between coronary artery calcifications and 6-month mortality in hospitalized patients with COVID-19
Elie Mousseaux1, Antoine Fayol2, Nicolas Danchin3
1Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Assistance Publique-Hôpitaux des Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Institut National de la Santé et de la Recherche Médicale, PARCC, UMR970, 75015 Paris, France.
Insights
High coronary artery calcium (CAC) scores, detected via CT scans, are linked to increased 6-month mortality in hospitalized COVID-19 patients. This finding highlights CAC as a significant predictor of severe outcomes in COVID-19 survivors.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- The coronavirus disease 2019 (COVID-19) pandemic has led to significant mortality, particularly among hospitalized patients.
- Identifying predictors of mortality in COVID-19 is crucial for risk stratification and management.
- Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis and a predictor of cardiovascular events.
Purpose of the Study:
- To investigate the association between visual coronary artery calcium (CAC) scoring and 6-month mortality in patients hospitalized with COVID-19.
- To determine if CAC, assessed on routine computed tomography (CT) scans, can predict mortality in this patient population.
Main Methods:
- A prospective observational cohort study included 169 hospitalized COVID-19 patients.
- Visual CAC scoring was performed on non-electrocardiogram-gated CT images obtained for pneumonia detection.
- Patients were followed for 6 months to assess mortality outcomes.
Main Results:
- Of 169 patients, 37% had moderate or heavy CAC. Mortality at 6 months was 26.6% overall.
- Mortality rates increased significantly with higher CAC scores (10.9% for no CAC to 45.9% for heavy CAC; P=0.001).
- Heavy CAC independently predicted increased 6-month mortality (HR: 5.38; P=0.007) after adjustment, especially in patients without prior coronary artery disease.
Conclusions:
- Visual CAC scoring on initial CT scans can identify COVID-19 patients at higher risk of 6-month mortality.
- Heavy CAC is an independent predictor of mortality in hospitalized COVID-19 patients, even those without a history of cardiovascular disease.
- Integrating CAC assessment into routine CT imaging may aid in risk-stratifying COVID-19 patients.
Purpose:
The purpose of this study was to evaluate the association between coronary artery calcium (CAC) visual score and 6-month mortality in patients with coronavirus disease 2019 (COVID-19).
Material And Methods:
A single-center prospective observational cohort was conducted in 169 COVID-19 consecutive hospitalized patients between March 13 and April 1, 2020, and follow-up for 6-months. A four-level visual CAC scoring was assessed by analyzing images obtained after the first routine non-ECG-gated CT performed to detect COVID-19 pneumonia.
Results:
Among 169 confirmed COVID-19 patients (118 men, 51 women; mean age, 65.6 ± 18.8 [SD] years; age range: 30-95 years) 63 (37%) presented with either moderate (n = 26, 15.3%) or heavy (n = 37, 21.8%) CAC detected by CT and 20 (11.8%) had history of cardiovascular disease requiring specific preventive treatment. At six months, mortality rate (45/169; 26.6%) increased with magnitude of CAC and was 7/64 (10.9%), 11/42 (26.2%), 10/26 (38.5%), 17/37 (45.9%) for no-CAC, mild-CAC, moderate-CAC and heavy-CAC groups, respectively (P = 0.001). Compared to the no CAC group, risk of death increased after adjustment with magnitude of CAC (HR: 2.23, 95% CI: 0.73-6.87, P = 0.16; HR: 2.78, 95% CI: 0.85-9.07, P0.09; HR: 5.38, 95% CI: 1.57-18.40, P = 0.007; in mild CAC, moderate and heavy CAC groups, respectively). In patients without previous coronary artery disease (154/169; 91%), mortality increased from 10.9% to 45.8% (P = 0.001) according to the magnitude of CAC categories. After adjustment, presence of moderate or heavy CAC was associated with higher mortality (HR: 2.26, 95% CI: 1.09-4.69, P = 0.03).
Conclusion:
By using non-ECG-gated CT during the initial pulmonary assessment of COVID-19, heavy CAC is independently associated with 6-month mortality in patients hospitalized for severe COVID-19 pneumonia.
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