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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Incremental Prognostic Value of Coronary Artery Calcium Score for Predicting All-Cause Mortality after Transcatheter
Matthias Eberhard1, Ricarda Hinzpeter1, Amadea L N Schönenberger1
1From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.).
Insights
Coronary artery calcium (CAC) scoring predicts mortality after transcatheter aortic valve replacement (TAVR). A high CAC score independently predicts 30-day and 1-year mortality, improving risk prediction beyond existing models.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Current risk models for transcatheter aortic valve replacement (TAVR) have limited predictive performance for all-cause mortality.
- There is a need for improved risk stratification in patients undergoing TAVR.
Purpose of the Study:
- To evaluate the prognostic value of coronary artery calcium (CAC) scoring in predicting 30-day and 1-year mortality in TAVR patients.
- To assess if CAC scoring can enhance existing risk prediction models.
Main Methods:
- Secondary analysis of prospectively collected data from the SwissTAVI Registry.
- Inclusion of patients who underwent pre-TAVR CT scans for CAC scoring and had no prior coronary revascularization.
- Cox regression analyses were used to assess the association between CAC score, EuroSCORE II, and mortality.
Main Results:
- A CAC score of 1000 or greater was an independent predictor of 30-day (HR, 4.5) and 1-year (HR, 4.3) mortality after TAVR.
- EuroSCORE II also independently predicted mortality, with similar trends observed.
- Adding CAC score to EuroSCORE II incrementally improved the prediction of 1-year mortality (concordance index, 0.76 vs 0.69).
Conclusions:
- Coronary artery calcium scoring is an independent predictor of short-term and long-term mortality in TAVR patients without prior coronary revascularization.
- CAC scoring offers incremental prognostic value when combined with existing risk scores like EuroSCORE II.
- CAC scoring may improve risk stratification and patient selection for TAVR.
Abstract:
Background Current risk models show limited performances for predicting all-cause mortality after transcatheter aortic valve replacement (TAVR). Purpose To determine the prognostic value of coronary artery calcium (CAC) scoring for predicting 30-day and 1-year mortality in patients undergoing TAVR. Materials and Methods In this single-center institutional review board-approved secondary analysis of prospectively collected data (SwissTAVI Registry), the authors evaluated participants who, before TAVR, underwent CT that included a nonenhanced electrocardiography-gated cardiac scan between May 2008 and September 2019 and who had not undergone previous coronary revascularization. Clinical data, including the European System for Cardiac Operative Risk Evaluation (EuroSCORE II), were recorded. The CAC score was determined, and 30-day and 1-year all-cause mortality were assessed by using Cox regression analyses. Results In total, 309 participants (mean age ± standard deviation, 81 years ± 7; 175 women) were included, with a median CAC score of 334 (interquartile range, 104-987). Seventy-seven of the 309 participants (25%) had a CAC score greater than or equal to 1000. A CAC score of 1000 or greater served as an independent predictor of 30-day (hazard ratio [HR], 4.5 [95% CI: 1.5, 13.6] compared with a CAC score <1000; P = .007) and 1-year (HR, 4.3 [95% CI: 1.5, 12.7] compared with a CAC score of 0-99; P = .008) mortality after TAVR. Similar trends were observed for each point increase of the EuroSCORE II as an independent predictor of 30-day (HR, 1.22 [95% CI: 1.10, 1.36]; P < .001) and 1-year (HR, 1.16 [95% CI: 1.08, 1.25]; P < .001) mortality. Adding the CAC score to the EuroSCORE II provided incremental prognostic value for 1-year mortality after TAVR over the EuroSCORE II alone (concordance index, 0.76 vs 0.69; P = .04). Conclusion In participants without prior coronary revascularization, the coronary artery calcium score represented an independent predictor of 30-day and 1-year mortality after transcatheter aortic valve replacement. ClinicalTrials.gov identifier, NCT01368250 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Almeida in this issue.
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