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Updated: Jul 2, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Long-term all-cause death prediction by coronary, aortic, and valvular calcification in patients with acute
Yalin Cheng1, Xuyang Meng1, Haiyang Gao1
1Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Insights
A cumulative calcification score, including coronary artery, thoracic aorta, and aortic valve calcification, independently predicts long-term mortality in ST-elevation myocardial infarction (STEMI) patients. This score offers valuable prognostic information for STEMI survivors post-primary percutaneous coronary intervention.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Acute ST-elevation myocardial infarction (STEMI) poses significant long-term mortality risks.
- Assessing prognostic factors in STEMI patients is crucial for guiding treatment and follow-up.
- Existing risk scores may not fully capture the impact of systemic calcification.
Purpose of the Study:
- To evaluate the prognostic value of a cumulative calcification score in STEMI patients.
- To assess the predictive capability of combined coronary artery, thoracic aortic, and aortic valve calcification.
- To compare the performance of this score against the GRACE risk score for mortality prediction.
Main Methods:
- Retrospective cohort study of 332 STEMI patients undergoing primary percutaneous coronary intervention (PPCI).
- Calculation of a cumulative calcification score based on calcification in LAD, LCX, RCA, thoracic aorta, and aortic valve.
- Analysis using Cox proportional hazards models, ROC curves, and net reclassification improvement (NRI) compared to GRACE score.
Main Results:
- A cumulative calcification score of 4-5 was independently associated with all-cause death (HR 2.32).
- The calcification score demonstrated a significant association with mortality (log-rank p < 0.001).
- While GRACE score had higher AUC for 3-year mortality, the calcification score showed superior risk classification via NRI (6.63%, P=0.027).
Conclusions:
- The cumulative calcification score is an independent predictor of long-term mortality in STEMI patients post-PPCI.
- This score provides valuable prognostic information beyond traditional risk scores.
- Further research may integrate this score into clinical risk stratification for STEMI management.
Background:
To determine the prognostic value of cumulative calcification score of coronary artery calcification (CAC), thoracic aortic calcification (TAC) and aortic valve calcification (AVC) in acute ST segment elevation myocardial infarction (STEMI) patients.
Methods:
This was a retrospective, single-center cohort study. A total of 332 STEMI patients who received primary percutaneous coronary intervention (PPCI) were enrolled in this study between January 2010 to October 2018. We assessed the calcification in the left anterior descending branch (LAD), left circumflex branch (LCX), right coronary artery (RCA), thoracic aorta, and aortic valve. Calcification of each part was counted as 1 point, and the cumulative calcification score was calculated as the sum of all points. The primary endpoint was all-cause mortality. Multivariate Cox proportional hazards models were used to determine association of cumulative calcification score with end points. The performance of the score was evaluated by receiver operating characteristic (ROC) curve analysis and absolute net reclassification improvement (NRI), compared with the Global Registry of Acute Coronary Events (GRACE) risk score.
Results:
The overall population's calcification score was 2.0 ± 1.6. During a mean follow-up time of 69.8 ± 29.3 months, the all-cause mortality rate was 12.1%. Kaplan-Meier curve showed that the score was significantly associated with mortality (log-rank p < 0.001). The multivariable Cox proportional hazard analyses showed that a calcification score of 4-5 was independently associated with all-cause death in STEMI patients [hazard ratio (HR) = 2.32, 95% confidence interval (CI): 1.01-5.31, p = 0.046]. The area under the ROC curve (AUC) of the calcification score was 0.67 (95% CI: 0.61-0.72), and the AUC of the GRACE score was 0.80 (95% CI: 0.75-0.84). There was no statistical difference in the predictive value between both scores for 3-year mortality in STEMI patients after PPCI (p = 0.06). Based on the NRI analysis, the calcification score showed better risk classification compared with the GRACE score (absolute NRI = 6.63%, P = 0.027).
Conclusion:
The cumulative calcification score is independently associated with the long-term prognosis of STEMI patients after PPCI.
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