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Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
Iliac Calcium Score thresholds predict cardiovascular and limb-related outcomes in TASC D aortoiliac disease
António Pereira-Neves1,2, João Rocha-Neves1,3,4, Tiago Costa-Pereira2,5
1Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.
Insights
A high Iliac Calcium Score (ICS) predicts poor outcomes in severe aortoiliac disease. This CT-based score aids in risk stratification for major adverse limb events (MALE) and cardiovascular events (MACE).
Area of Science:
- Vascular Surgery
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Extensive lower limb arterial calcification, especially in TASC II D aortoiliac lesions, complicates revascularization and is linked to adverse outcomes.
- Standardized scoring systems for iliac artery calcification are lacking, hindering accurate risk stratification.
Purpose of the Study:
- To evaluate the prognostic value of a CT-based Iliac Calcium Score (ICS) in predicting major adverse limb events (MALE), major adverse cardiovascular events (MACE), and all-cause mortality.
- To assess the utility of ICS in patients with severe aortoiliac occlusive disease (TASC II D).
Main Methods:
- Prospective cohort study of 109 patients with TASC II D aortoiliac occlusive disease undergoing elective revascularization.
- Preoperative CT angiography was used to semiquantitatively score iliac artery calcification (ICS).
- Patients were stratified into low (≤ 36) and high (≥ 37) ICS groups; outcomes analyzed using Kaplan-Meier and Cox regression.
Main Results:
- A high ICS (≥ 37) was associated with more advanced Rutherford stages and greater MALE at 1 year (48.1% vs. 27.3%).
- At 60 months, high ICS group had significantly lower amputation-free survival (74.5% vs. 97.8%), MACE-free survival (47.3% vs. 73.4%), and overall survival (54.6% vs. 77.0%).
- High ICS independently predicted MACE (aHR 2.30) and major amputation (aHR 7.52).
Conclusions:
- An ICS ≥ 37 is an independent predictor of increased long-term MACE, MALE, and reduced survival in patients with TASC II D disease.
- Preoperative calcium scoring using ICS can serve as a valuable tool for risk stratification, procedural planning, and personalized surveillance in complex peripheral arterial disease.
Introduction:
Extensive lower limb arterial calcification complicates revascularization and is linked to poor outcomes, including limb loss and cardiovascular events. Standardized scoring systems are lacking, particularly in aortoiliac TASC II D lesions. This study evaluated the prognostic value of a CT-based Iliac Calcium Score (ICS) in predicting major adverse limb events (MALE), cardiovascular events (MACE), and all-cause mortality in patients with severe aortoiliac disease.
Methods:
In this prospective cohort (2013-2024), 109 patients with TASC II D aortoiliac occlusive disease underwent elective revascularization and preoperative CT angiography. Iliac artery calcification was scored semiquantitatively by morphology, circumference, and lesion length. Patients were stratified into low (≤ 36) and high (≥ 37) ICS groups. Outcomes included MALE, MACE, and mortality, analyzed using Kaplan-Meier and Cox regression.
Results:
The study included 109 patients (95.4% male) with a median follow-up of 67 months. Baseline characteristics were similar across ICS groups, though ICS ≥ 37 was associated with more advanced Rutherford stages (p = 0.035). At 30 days, both groups improved clinically, but Rutherford class improvement was greater in the ICS ≤ 36 group (p = 0.013), with no other significant differences. At 1 year, MALE was more frequent in patients with ICS ≥ 37 (48.1% vs. 27.3%; p = 0.024). At 60 months, this group showed significantly lower amputation-free (74.5% vs. 97.8%; p = 0.002), MACE-free (47.3% vs. 73.4%; p = 0.005), and overall survival (54.6% vs. 77.0%; p = 0.013). Acute heart failure occurred only in the high ICS group (p = 0.015), while patency rates were similar. ICS ≥ 37 remained an independent predictor of MACE (aHR 2.30; p = 0.008) and major amputation (aHR 7.52; p = 0.008) in multivariable analysis.
Conclusion:
In patients with extensive TASC II D aortoiliac occlusive disease, an ICS ≥ 37 was independently associated with increased long-term risk of MACE, MALE, and reduced overall survival, despite similar short-term outcomes. These findings support the integration of preoperative calcium scoring as a simple, lesion-specific tool for risk stratification, procedural planning, and personalized postoperative surveillance in complex peripheral arterial disease.
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