Related Experiment Video
Updated: May 15, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting
Maxence Brunel1, Brahim Harbaoui1,2, Laurent Bitker2,3
1Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, Lyon, F-69004, France.
Insights
A visual coronary artery calcification (VCAC) score from chest CT can effectively identify patients with cardiac arrest and non-ST-segment elevation myocardial infarction (non-STEMI) who may benefit from emergency coronary angiography.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Emergency coronary angiography post-cardiac arrest without STEMI is debated.
- Selecting appropriate patients for this procedure is crucial.
Purpose of the Study:
- To evaluate the utility of a visual coronary artery calcification (VCAC) score from chest CT scans.
- To predict significant coronary artery stenosis, culprit lesions, and the need for percutaneous coronary intervention (PCI) in cardiac arrest patients without STEMI.
Main Methods:
- Retrospective analysis of 113 patients who underwent coronary angiogram and chest CT after cardiac arrest without STEMI.
- VCAC scoring (0-3) for four main coronary arteries.
- Correlation of VCAC score with angiographic findings and PCI outcomes.
Main Results:
- VCAC score accurately predicted significant coronary artery stenosis (AUC 0.95) and culprit lesions (AUC 0.90).
- An optimal VCAC threshold of ≥4 predicted significant stenosis with 91.9% sensitivity and 94.7% specificity.
- VCAC score ≥5 predicted the need for ad hoc or delayed PCI with high accuracy (AUC 0.89-0.92).
- A VCAC score ≥4 demonstrated 100% sensitivity for predicting significant or culprit coronary artery stenosis and need for PCI.
Conclusions:
- Non-dedicated chest CT can be used to assess VCAC.
- A VCAC score ≥4 aids in selecting patients resuscitated from cardiac arrest (without STEMI) for emergency coronary angiography.
- This selection process can identify patients who may benefit from PCI for significant coronary artery stenosis.
Background:
Emergency coronary angiogram after a cardiac arrest without ST-segment elevation myocardial infarction (STEMI) is still a matter of debate. To better select patients who may benefit from this procedure, we tested a visual coronary artery calcification (VCAC) score available in chest CT to predict significant coronary artery stenosis and/or culprit lesion or ad hoc or delayed percutaneous coronary intervention (PCI).
Results:
A total of 113 patients with cardiac arrest and without STEMI who had a coronary angiogram and chest CT (January 2013 to March 2023, Croix-Rousse Hospital, Lyon, France) were retrospectively included. VCAC was scored from 0 (no calcification) to 3 (diffuse calcification) for each 4 four main arteries (left main, left anterior descending, circumflex, and right coronary artery). At baseline the median [interquartile range] age was 65.8 years [53.4-75.7], 61.9% were male, and 59.3% presented with ventricular fibrillation. Coronary angiogram identified at least one significant coronary artery stenosis in 32.7%, and ad hoc and delayed PCI were performed in 12.4% and 6.2% of the patients, respectively. VCAC score was an excellent predictor of significant coronary artery stenosis with an area under the ROC curve (AUC) of 0.95 (95%CI [0.90-1.00]) and the optimal threshold was ≥ 4 (specificity 94.7%, sensitivity 91.9%). For the detection of culprit coronary artery stenosis, the AUC was at 0.90 (95%CI [0.85-0.96]) and the optimal threshold was ≥ 5 (specificity 83.5%, sensitivity 87.5%). The AUC was 0.886 [0.823-0.948] (specificity 81.8%, sensitivity 85.7%) for ad hoc PCI and 0.921 [0.872-0.972] (specificity 85.3%, sensitivity 88.9%) for both delayed and ad hoc PCI with a same optimal threshold of VCAC ≥ 5. A VCAC score ≥ 4 had a sensitivity at 100% to predict a significant or culprit coronary artery stenosis and ad hoc or delayed PCI.
Conclusions:
The present study found that a non-dedicated CT thorax may be useful to measure VCAC and if this is scored ≥ 4 it allows physicians to better select patients resuscitated from cardiac arrest with non-STEMI and without history of coronary artery disease who may benefit from an emergency coronary angiogram to detect a significant or culprit coronary artery stenosis and had PCI if appropriate.
More Related Videos
06:57Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
