Related Experiment Video
Updated: Aug 6, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcification on routine CT has prognostic and treatment implications for all ages
J Graby1, J Soto-Hernaez2, D Murphy3
1Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK; Department for Health, University of Bath, Claverton Down, Bath BA2 7AY, UK.
Insights
Reporting coronary artery calcification (CAC) found on chest CTs is valuable across all ages. This imaging finding, present in 54% of patients, predicts mortality risk and can impact management decisions, even in younger individuals.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Current guidelines recommend reporting coronary artery calcification (CAC) detected on chest CT scans, irrespective of the scan's primary purpose.
- The clinical significance and prognostic value of CAC in diverse patient populations, particularly those not undergoing cardiac-specific imaging, require further elucidation.
Purpose of the Study:
- To assess the prevalence and severity of CAC in a broad age spectrum using chest CT imaging.
- To evaluate the prognostic implications of CAC, including its association with cardiovascular events and all-cause mortality.
- To determine the potential clinical impact of reporting incidental CAC on patient management, specifically regarding statin prescriptions.
Main Methods:
- A retrospective analysis of 1400 chest CT scans from January to December 2015 was conducted, with patients stratified into age groups.
- Coronary artery calcification (CAC) presence and severity were re-evaluated by observers, with inter- and intra-observer variability assessed.
- Clinical data, including comorbidities, statin use, and outcomes (myocardial infarction, stroke, mortality), were collected to analyze prognostic associations and management impact.
Main Results:
- Out of 1343 included patients, 54% had detectable CAC, with higher prevalence in males and increasing with age.
- CAC was observed in a significant proportion of patients across all age groups, with many lacking prior statin prescriptions.
- CAC presence was significantly associated with increased risk of myocardial infarction, stroke, and all-cause mortality (p < 0.001); severe calcification independently predicted mortality (HR 1.8).
Conclusions:
- The grading of coronary artery calcification (CAC) on chest CT is reproducible across observers.
- While CAC prevalence increases with age, its prognostic significance and potential impact on treatment decisions are relevant across all adult age groups.
- Reporting incidental CAC on chest CTs has the potential to influence patient management and risk stratification, underscoring its clinical utility.
Aims:
Guidelines have recommended reporting coronary artery calcification (CAC) if present on chest CT imaging regardless of indication. This study assessed CAC prevalence, prognosis and the potential clinical impact of its reporting.
Methods:
We performed a single-centre retrospective analysis (January-December 2015) of 1400 chest CTs (200 consecutive within each age group: <40, 40-49, 50-59, 60-69, 70-79, 80-89, ≥90). CTs were re-reviewed for CAC presence and severity and excluded if prior coronary intervention. Comorbidities, statin prescription and clinical outcomes (myocardial infarction [MI], stroke, all-cause mortality) were recorded. The impact of reporting CAC was assessed against pre-existing statin prescriptions.
Results:
1343 patients were included (mean age 63±20 years, 56% female). Inter- and intra-observer variability for CAC presence at re-review was almost perfect (κ 0.89, p < 0.001; κ 0.90, p < 0.001) and for CAC grading was substantial and almost perfect (κ 0.68, p < 0.001; κ 0.91, p < 0.001). CAC was observed in 729/1343 (54%), more frequently in males (p < 0.001) and rising age (p < 0.001). A high proportion of patients with CAC in all age groups had no prior statin prescription (range: 42% [80-89] to 100% [<40]). The 'number needed to report' CAC presence to potentially impact management across all ages was 2. 689 (51%) patients died (median follow-up 74-months). CAC presence was associated with risk of MI, stroke and all-cause mortality (p < 0.001). After adjusting for confounders, severe calcification predicted risk of all-cause mortality (HR 1.8 [1.2-2.5], p = 0.002).
Conclusion:
Grading of CAC was reproducible, and although prevalence rose with age, prognostic and treatment implications were maintained in all ages.
More Related Videos
06:57Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
08:02Author Spotlight: Enhanced Quantification of Cardiovascular Calcification Progression for Longitudinal Micro PET/CT Studies in Small Research Animals
Published on: November 15, 2024
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Imaging Studies for Cardiovascular System V: CT
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures
01:27Coronary Artery Disease V: Interprofessional Care