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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Visual Coronary and Aortic Calcium Scoring on Chest Computed Tomography Predict Mortality in Patients With
Francesco Castagna1,2, Jeremy Miles2, Javier Arce1
1Cardiology Division, Montefiore Medical Center, Bronx, NY (F.C., J.M., J.A., E.L., P.N., P.I., A.S., L.Z., C.J.R., M.J.G., L.S.).
Insights
Coronary artery calcium (CAC) and thoracic aorta calcification (TAC) detected on CT scans are linked to increased mortality in patients with high LDL-C. These calcifications can help stratify risk beyond traditional measures.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Current guidelines limit coronary artery calcium (CAC) scoring to intermediate cardiovascular disease risk.
- The role of CAC and thoracic aorta calcification (TAC) in high LDL-C patients (≥190 mg/dL) is unclear.
- Routine chest CTs may offer additional risk stratification opportunities.
Purpose of the Study:
- To investigate if CAC and TAC scores on routine chest CTs improve risk stratification for all-cause mortality.
- To assess the association of CAC and TAC with mortality in patients with LDL-C ≥190 mg/dL and no established atherosclerotic cardiovascular disease.
Main Methods:
- Retrospective analysis of 811 patients (age ≥40) with LDL-C ≥190 mg/dL and available chest CTs.
- Visual assessment of ordinal CAC and TAC scores.
- Kaplan-Meier curves and Cox-regression models to determine the association with all-cause mortality.
Main Results:
- All-cause mortality increased with the presence and severity of CAC and TAC.
- CAC was significantly associated with higher mortality (HRs ranging from 1.71 to 3.49).
- Moderate to severe TAC was also linked to increased mortality (HRs of 2.34 and 3.02).
Conclusions:
- CAC and TAC are independently associated with all-cause mortality in patients with LDL-C ≥190 mg/dL.
- These calcifications provide valuable risk stratification beyond traditional methods.
- Chest CT findings of CAC and TAC can aid in managing high-risk cardiovascular patients.
Background:
Current guidelines recommend coronary artery calcium (CAC) scoring for stratification of atherosclerotic cardiovascular disease risk only in patients with borderline to intermediate risk score by the pooled cohort equation with low-density lipoprotein-cholesterol (LDL-C) of 70 to 190 mg/dL. It remains unknown if CAC or thoracic aorta calcification (TAC), detected on routine chest computed tomography, can provide further risk stratification in patients with LDL-C≥190 mg/dL.
Methods:
From a multisite medical center, we retrospectively identified all patients from March 2005 to June 2021 age ≥40 years, without established atherosclerotic cardiovascular disease and LDL-C≥190 mg/dL who had non-gated non-contrast chest computed tomography within 3 years of LDL-C measurement. Ordinal CAC and TAC scores were measured by visual inspection. Kaplan-Meier curves and multivariable Cox-regression models were built to ascertain the association of CAC and TAC scores with all-cause mortality.
Results:
We included 811 patients with median age 59 (53-68) years, 262 (32.3%) were male, and LDL-C median level was 203 (194-217) mg/dL. Patients were followed for 6.2 (3.29-9.81) years, and 109 (13.4%) died. Overall, 376 (46.4%) of patients had CAC=0 and 226 (27.9%) had TAC=0. All-cause mortality increased with any CAC and moderate to severe TAC. In a multivariate model, patients with CAC had a significantly higher mortality compared with those without CAC: mild hazard ratio (HR), 1.71 (1.03-2.83), moderate HR, 2.12 (1.14-3.94), and severe HR, 3.49 (1.94-6.27). Patients with moderate TAC (HR, 2.34 [1.19-4.59]) and those with severe TAC (HR, 3.02 [1.36-6.74]) had higher mortality than those without TAC.
Conclusions:
In patients without history of atherosclerotic cardiovascular disease and LDL-C≥190 mg/dL, the presence and severity of CAC and TAC are independently associated with all-cause mortality.
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