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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Visual Ordinal Coronary Artery Calcium Score from Non-Gated Chest CT Predicts Mortality After Severe Chronic
1Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
Insights
Coronary artery calcium (CAC) on chest CT predicts mortality in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Higher CAC scores (4-12) significantly increase mortality risk, independent of other factors.
Area of Science:
- Cardiology
- Pulmonology
- Radiology
Background:
- Chronic obstructive pulmonary disease (COPD) patients frequently undergo chest CT scans.
- Coronary artery calcium (CAC) can be assessed using an ordinal score on non-gated chest CT, correlating with Agatston scores.
- Previous studies on CAC prognosis primarily focused on stable COPD patients.
Purpose of the Study:
- To investigate the association between ordinal CAC scores and mortality in patients admitted for acute exacerbation of COPD (AECOPD).
- To determine if CAC, assessed via ordinal scoring on chest CT, is a predictor of mortality in AECOPD.
- To evaluate the prognostic value of CAC in a specific high-risk COPD population.
Main Methods:
- Retrospective analysis of AECOPD patients admitted between January 2016 and June 2017, with chest CTs performed during admission or within 365 days prior.
- Ordinal CAC scoring (0-12) was conducted by a blinded CT cardiologist.
- Demographic data, clinical history, and mortality outcomes were extracted from electronic medical records.
Main Results:
- The study included 93 AECOPD patients (87.1% male, mean age 75).
- Over a median follow-up of 2.9 years, 54.8% of patients died.
- An ordinal CAC score of 4-12 was identified as an independent predictor of mortality (HR 3.944, p=0.002) after adjusting for multiple variables.
Conclusions:
- Ordinal CAC, quantifiable from ungated chest CT, serves as an independent predictor of all-cause mortality in AECOPD patients.
- This method offers a valuable prognostic tool for identifying high-risk individuals among those hospitalized for AECOPD.
- Routine chest CTs in AECOPD patients can provide prognostic information regarding cardiovascular risk and overall survival.
Purpose:
Chronic obstructive pulmonary disease (COPD) patients often undergo chest CT for various indications. Coronary artery calcium (CAC) can be quantified visually on ungated chest CT using an ordinal score that has been shown to correlate well with traditional Agatston CAC scoring. The prognostic role of CAC was studied mainly in stable COPD patients. We aim to study the association between ordinal CAC and mortality amongst patients admitted for acute exacerbation of COPD (AECOPD).
Patients And Methods:
Retrospective study of AECOPD cases with no previous coronary revascularization admitted between 1st January 2016 to 30th June 2017 with a chest CT performed during admission or within 365 days prior. Ordinal CAC scoring (scale of 0-12) was performed by an experienced CT cardiologist blinded to patient data and outcomes. Patient demographics and future clinical events were retrieved from electronic medical records.
Results:
There were 93 patients included (87.1% male, mean age 75 years) with the majority (59.1%) in GOLD Stage III. There were 21 (22.6%) patients with no CAC as well as 39 (41.9%) and 33 (35.5%) with ordinal CAC of 1-3 and 4-12, respectively. There were no significant differences in Charlson Comorbidity Index (CCI) and the proportion of patients with traditional cardiovascular risk factors (namely hypertension, dyslipidaemia, diabetes and smoking status) between the ordinal CAC score groups. Over a median follow-up period of 2.9 (1.1-3.9) years, there were 51 (54.8%) deaths. An ordinal CAC score of 4-12 was the only significant predictor of mortality after multivariate Cox-regression analysis adjustment for age, gender, body mass index, prior exacerbations, FEV1, cardiovascular risk factors and CCI [HR 3.944, (95% confidence interval 1.647-9.433, p = 0.002)].
Conclusion:
Ordinal CAC measured from a current or recent ungated chest CT is an independent predictor of all-cause mortality in admitted AECOPD patients with no previous coronary revascularization.
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