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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging With Cardiovascular Outcomes
Allison W Peng1, Ramzi Dudum2, Sneha S Jain2
1Department of Medicine, Stanford University, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA. Electronic address: https://twitter.com/AllisonWPeng.
Insights
Deep learning-quantified coronary artery calcium (CAC) on routine CT scans identifies individuals at higher risk for cardiovascular events and death. This opportunistic screening method using deep learning-CAC can aid in earlier interventions for at-risk patients.
Area of Science:
- Cardiology
- Radiology
- Artificial Intelligence
Background:
- Coronary artery calcium (CAC) is a significant predictor of cardiovascular events across diverse populations.
- CAC can be incidentally quantified on non-electrocardiography (ECG)-gated computed tomography (CT) scans, enabling opportunistic screening for subclinical atherosclerosis.
Purpose of the Study:
- To evaluate if incidental CAC, quantified by a deep-learning (DL) algorithm on routine non-ECG-gated CTs, offers cardiovascular risk stratification beyond traditional methods.
- To assess the association of DL-quantified CAC (DL-CAC) with adverse cardiovascular outcomes.
Main Methods:
- DL algorithm used to quantify incidental CAC on non-ECG-gated chest CTs from 2014-2019.
- Association of DL-CAC (0, 1-99, or ≥100) with all-cause death, and composite outcomes of death/myocardial infarction (MI)/stroke, and death/MI/stroke/revascularization analyzed using Cox regression.
- Adjusted for traditional risk factors and calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk using pooled cohort equations.
Main Results:
- 52% of 5,678 adults without ASCVD had DL-CAC >0; those with DL-CAC ≥100 had a 24% average 10-year ASCVD risk, with only 26% on statins.
- Adjusted analysis showed DL-CAC ≥100 was associated with increased risk of death (HR: 1.51), death/MI/stroke (HR: 1.57), and death/MI/stroke/revascularization (HR: 1.69) compared to DL-CAC = 0.
- Incidental CAC ≥100 identified increased risk beyond traditional factors.
Conclusions:
- Incidental CAC ≥100 is linked to higher risks of all-cause death and adverse cardiovascular outcomes.
- DL-CAC from routine CT scans effectively identifies patients at elevated cardiovascular risk.
- DL-CAC shows promise as an opportunistic screening tool for facilitating earlier cardiovascular interventions.
Background:
Coronary artery calcium (CAC) is a strong predictor of cardiovascular events across all racial and ethnic groups. CAC can be quantified on nonelectrocardiography (ECG)-gated computed tomography (CT) performed for other reasons, allowing for opportunistic screening for subclinical atherosclerosis.
Objectives:
The authors investigated whether incidental CAC quantified on routine non-ECG-gated CTs using a deep-learning (DL) algorithm provided cardiovascular risk stratification beyond traditional risk prediction methods.
Methods:
Incidental CAC was quantified using a DL algorithm (DL-CAC) on non-ECG-gated chest CTs performed for routine care in all settings at a large academic medical center from 2014 to 2019. We measured the association between DL-CAC (0, 1-99, or ≥100) with all-cause death (primary outcome), and the secondary composite outcomes of death/myocardial infarction (MI)/stroke and death/MI/stroke/revascularization using Cox regression. We adjusted for age, sex, race, ethnicity, comorbidities, systolic blood pressure, lipid levels, smoking status, and antihypertensive use. Ten-year atherosclerotic cardiovascular disease risk was calculated using the pooled cohort equations.
Results:
Of 5,678 adults without ASCVD (51% women, 18% Asian, 13% Hispanic/Latinx), 52% had DL-CAC >0. Those with DL-CAC ≥100 had an average 10-year ASCVD risk of 24%; yet, only 26% were on statins. After adjustment, patients with DL-CAC ≥100 had increased risk of death (HR: 1.51; 95% CI: 1.28-1.79), death/MI/stroke (HR: 1.57; 95% CI: 1.33-1.84), and death/MI/stroke/revascularization (HR: 1.69; 95% CI: 1.45-1.98) compared with DL-CAC = 0.
Conclusions:
Incidental CAC ≥100 was associated with an increased risk of all-cause death and adverse cardiovascular outcomes, beyond traditional risk factors. DL-CAC from routine non-ECG-gated CTs identifies patients at increased cardiovascular risk and holds promise as a tool for opportunistic screening to facilitate earlier intervention.
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