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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Burden of coronary artery calcification in ANCA-associated vasculitis
Michael Hendrickson1, Anushri Parakh2, Brittany Weber3
1Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Cardiovascular disease is a major risk in ANCA-associated vasculitis (AAV). Many AAV patients have significant coronary artery calcium (CAC) scores, indicating high CVD risk, but statin use is inconsistent.
Area of Science:
- Cardiology
- Rheumatology
- Radiology
Background:
- Cardiovascular disease (CVD) is a primary cause of mortality in ANCA-associated vasculitis (AAV).
- Proactive screening and primary CVD prevention strategies are crucial for improving patient outcomes in AAV.
- Coronary artery calcium (CAC) scoring on CT scans can quantify CVD risk.
Purpose of the Study:
- To evaluate the prevalence and extent of coronary artery calcium (CAC) in patients with ANCA-associated vasculitis (AAV).
- To compare CAC burden between myeloperoxidase-ANCA (MPO-ANCA) and proteinase 3-ANCA (PR3-ANCA) positive AAV patients.
- To assess the utilization of statin therapy in AAV patients with significant CAC and its association with major adverse cardiac events (MACE).
Main Methods:
- Retrospective analysis of 175 AAV patients from the Mass General Brigham AAV cohort (2002-2019) with available thoracic CT scans.
- Calculation of coronary artery calcium (CAC) scores and age, sex, and race-standardized CAC percentiles.
- Quantile regression to compare CAC by ANCA type; Gray's test for MACE differences based on CAC score.
Main Results:
- A majority of patients (65/175, 39%) had CAC scores ≥100, indicating clinically significant coronary atherosclerosis.
- MPO-ANCA positive AAV patients exhibited higher median CAC scores (24 vs 1) and percentiles (50th vs 34th) compared to PR3-ANCA positive patients (p<0.05).
- Only 25% (29/116) of patients with non-zero CAC scores were prescribed statins; higher CAC scores trended towards increased MACE risk (p=0.16).
Conclusions:
- Clinically significant coronary artery calcium is prevalent in the AAV population.
- Differences in CAC burden exist between MPO-ANCA and PR3-ANCA subtypes.
- Inconsistent statin use for CVD prevention in AAV patients with high CAC warrants further investigation into CT-guided screening strategies.
Background:
Cardiovascular disease (CVD) is a leading cause of death in ANCA-associated vasculitis (AAV). Screening and primary cardiovascular prevention may improve outcomes.
Methods:
We identified patients in the 2002-2019 Mass General Brigham AAV cohort with thoracic CT scans obtained for other clinical purposes. Coronary artery calcium (CAC) scores and age, sex and race-standardised CAC percentiles were calculated. Quantile regression was used to identify differences by ANCA type, and Gray's test examined differences in major adverse cardiac events by CAC score.
Results:
Of 175 included patients, 127 (73%) were MPO-ANCA+and 48 (27%) were PR3-ANCA+. The median CAC score was 17 (IQR 0, 334) and CAC percentile was 45 (IQR 0, 78); 65 (39%) patients had CAC of ≥100. The total CAC score was higher in patients with MPO-ANCA+AAV vs PR3-ANCA+AAV (median 24 vs 1, p=0.003), as was the standardised CAC percentile (50th vs 34th, p=0.02). Of 116 (66%) patients with non-zero CAC scores, only 29 (25%) were on a statin. In a time-to-event analysis, CAC of 100 or higher trended towards association with higher risk of major adverse cardiovascular events (χ2=1.9, p=0.16).
Conclusion:
A majority of patients with AAV had clinically significant CAC. There were differences in CAC burden among those with MPO-ANCA+AAV versus PR3-ANCA+AAV. Although CAC is associated with CVD risk and an indication for statins, the use was inconsistent. The role of CT imaging to screen for CVD and guide primary prevention in AAV requires further study.
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