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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Does the absence of breast arterial calcification (BAC 0) rule out severe coronary artery disease? A computed
Johannes Deeg1, Michael Swoboda1, Valentin Bilgeri2
1Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
Insights
Breast arterial calcifications (BAC) do not rule out significant coronary artery disease in women over 55. BAC is not a reliable indicator for obstructive disease or high-risk plaques in symptomatic patients across all age groups.
Area of Science:
- Cardiology
- Radiology
- Women's Health
Background:
- Cardiovascular risk stratification in women is challenging, with current models underestimating risk.
- Breast arterial calcifications (BAC) are independent prognosticators, but their role alongside coronary artery disease (CAD) profiles is debated.
- The prognostic value of BAC, particularly in relation to coronary computed tomography (CT) findings, requires clarification.
Purpose of the Study:
- To investigate the interaction between BAC and coronary CT outcomes.
- To assess the relationship of BAC with coronary artery calcium (CAC) score, coronary stenosis severity, and high-risk plaque (HRP).
Main Methods:
- Retrospective analysis of consecutive patients undergoing both mammography (MG) and coronary CT angiography (CTA).
- Patients were stratified into three age groups: <55, 55-65, and >65 years.
- Comparison of BAC prevalence with CAC score, obstructive CAD (>50% stenosis), and HRP presence.
Main Results:
- Significant age-related differences were observed in BAC prevalence, high CAC (>300 AU), and obstructive CAD.
- High CAC was rare in women <55 with BAC (0.82%) but more frequent in older groups (12.1% in 55-65, 8.4% in >65).
- Obstructive CAD was present in 18.2% of women with BAC, increasing with age (10.7% vs. 14.7% vs. 29.9%). BAC showed weak correlation with CAC and CAD-RADS and no association with HRP.
Conclusions:
- BAC can help rule out severe CAC (>300 AU) only in women under 55.
- BAC does not rule out obstructive CAD or high-risk plaques in symptomatic women across any age group.
- These findings have implications for primary prevention strategies in women based on age and BAC presence.
Background:
Cardiovascular risk (CV)-stratification in females is challenging, and current models miss a high proportion at-risk. Breast arterial calcifications (BAC) are independent prognosticators, but their interaction with the coronary artery disease profile by computed tomography (CT) is controverse, and the role of BAC 0 unclear.
Objective:
to investigate the interaction of BAC with coronary CT outcomes (CAC score, coronary stenosis severity and high-risk plaque (HRP).
Methods:
Consecutive patients referred to mammography (MG) and coronary CTA for clinical indications within 1 year were included. Three different age groups were compared (<55 years;55-65 years;>65 years).
Results:
443 patients were included. There were significant age differences for the prevalence of BAC 0 (p<0.001), BAC 0/CAC>300 AU (p=0.0023) and obstructive disease (>50% stenosis)(p=0.0048) but not for high-risk-plaque (HRP)(p=0.4905). High CAC (>300 AU) was present in only 0.82% of females with BAC 0 in less than 55 year, but significantly more often in those above 65 years (p=0.0004;OR=16.58:95% CI: 2.829-361.7) and 55 years with 12.1% and 8.4%. Obstructive coronary disease (>50% stenosis) in BAC 0 was present in 18.2%; with age-dependent differences (10.7% vs 14.7% vs 29.9%) (p=0.0003). The correlation between BAC, CAC and CADRADS was weak (r=0.246 and r=0.243, p<0.001). There was no association of BAC with HRP.
Conclusion:
BAC 0 rules out severe CAC >300AU in females <55 years only, but not in those above 55 years- with adherent implications for primary prevention. However, BAC 0 does not to rule out obstructive disease and high-risk plaques in symptomatic patients among all age groups.
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