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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary Calcium Predicts All-Cause Mortality in Suspected Acute Aortic Syndrome
Duan Chen1, Alison R Schonberger1, Kenny Ye1
1From the Departments of Radiology (D.C., A.R.S., J.M.L.) and Medicine (J.M.L.), Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; and Departments of Epidemiology & Population Health (K.Y.), Systems and Computational Biology (K.Y.), Radiology (J.M.L.), and Medicine (J.M.L.), Albert Einstein College of Medicine, Bronx, NY.
Insights
Coronary calcium burden identified via CT aortography is a strong predictor of mortality in patients with suspected acute aortic syndrome (AAS). Higher calcium scores correlate with increased risk of death and major adverse cardiovascular events.
Area of Science:
- Cardiology
- Radiology
- Vascular Medicine
Background:
- Suspected acute aortic syndrome (AAS) carries a significant risk of long-term adverse clinical events, including mortality.
- Identifying prognostic markers in AAS is crucial for risk stratification and patient management.
Purpose of the Study:
- To determine long-term clinical outcomes in patients with suspected AAS.
- To evaluate the prognostic value of coronary calcium burden, assessed by CT aortography, in this population.
Main Methods:
- Retrospective cohort study of 1658 patients undergoing emergency CT aortography for suspected AAS (2007-2012).
- 10-year follow-up for clinical events including death, dissection, myocardial infarction, stroke, and pulmonary embolism.
- Coronary calcium scores calculated using a 12-point ordinal method; survival analysis performed.
Main Results:
- 595 patients (35.9%) experienced a clinical event over a median follow-up of 6.9 years.
- High coronary calcium scores were associated with the highest mortality (aHR=2.36).
- Low coronary calcium scores showed nearly double the mortality compared to no detectable calcium (aHR=1.89); coronary calcium independently predicted major adverse cardiovascular events (P<.001).
Conclusions:
- Patients with suspected AAS face a high rate of subsequent clinical events, particularly death.
- CT aortography-derived coronary calcium scores are a powerful and independent predictor of all-cause mortality in suspected AAS.
- Coronary artery calcium assessment during CT aortography can aid in risk stratification for patients presenting with suspected AAS.
Purpose:
To determine long-term clinical outcomes in patients with suspected acute aortic syndrome (AAS) and evaluate the prognostic value of coronary calcium burden as assessed with CT aortography in this symptomatic population.
Materials And Methods:
A retrospective cohort of all patients who underwent emergency CT aortography from January 2007 through January 2012 for suspected AAS was assembled. A medical record survey tool was used to evaluate subsequent clinical events over 10 years of follow-up. Events included death, aortic dissection, myocardial infarction, cerebrovascular accident, and pulmonary embolism. Coronary calcium scores were computed from original images using a validated simple 12-point ordinal method and categorized into none, low (1-3), moderate (4-6), or high (7-12) groupings. Survival analysis with Kaplan-Meier curves and Cox proportional hazard modeling was performed.
Results:
The study cohort comprised 1658 patients (mean age, 60 years ± 16 [SD]; 944 women), with 595 (35.9%) developing a clinical event over a median follow-up of 6.9 years. Patients with high coronary calcium demonstrated the highest mortality rate (adjusted hazard ratio = 2.36; 95% CI: 1.65, 3.37). Patients with low coronary calcium demonstrated lower mortality, but rates were still almost twice as high compared with patients with no detectable calcium (adjusted hazard ratio = 1.89; 95% CI: 1.41, 2.53). Coronary calcium was a strong predictor of major adverse cardiovascular events (P < .001), which persisted after adjustment for common significant comorbidities.
Conclusion:
Patients with suspected AAS had a high rate of subsequent clinical events, including death. CT aortography-based coronary calcium scores strongly and independently predicted all-cause mortality.Keywords: Acute Aortic Syndrome, Coronary Artery Calcium, CT Aortography, Major Adverse Cardiovascular Events, Mortality Supplemental material is available for this article. © RSNA, 2023See also commentary by Weir-McCall and Shambrook in this issue.
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