Cardiovascular Events in COPD: Complementary Role of Cardiac Risk and Coronary Artery Calcium Scores

Patients with COPD are at high risk of major adverse cardiovascular events (MACEs) developing. Existing clinical tools for risk stratification in these patients have underperformed in predicting the outcomes.

Does a combination of cardiovascular risk score (CVRS) and coronary artery calcium score (CACS) improve risk assessment of MACEs in patients with COPD?

This was an observational cohort of patients with COPD (n = 529). They underwent a chest CT scan, and clinical, functional, and laboratory data were recorded. The CACS and CVRS (Systematic Coronary Risk Evaluation [SCORE] 2, SCORE2-Older People [OP], SCORE2-Diabetes, and Secondary Manifestations of Arterial Disease [SMART] risk scores) were calculated. Using a threshold of CVRS of ≥ 10% or CACS score of > 3, patients were divided into 4 groups-group I, CVRS < 10% and CACS ≤ 3; group II, CVRS ≥ 10% and CACS ≤ 3; group III, CVRS < 10% and CACS > 3; and group IV, CVRS ≥ 10% and CACS > 3-who were followed up for a median of 98 months. Regression analysis and Kaplan Meier curves were used to compare the risks among groups. Receiver operating characteristic (ROC) curve analysis determined the performance of CACS and CVRS and their combination to predict MACEs.

Most patients were male (80%) with moderate COPD. Over time, 131 patients (24%) experienced a MACE. Compared with group I, the hazard ratios for MACEs were: group IV, 7.6 (95% CI, 4.9-11.9; P < .001); group III, 3.1 (95% CI, 1.8-8.5; P < .001); and group II, 2.6 (95% CI, 1.6-4.2; P < .001). The areas under the ROC curve for predicting MACEs were 0.72 (P < .01) for CACS plus CVRS compared with 0.69 for CVRS and 0.66 for CACS.

The combination of cardiovascular risk and coronary artery calcification scores were shown to provide a complementary role in MACE risk stratification in patients with COPD.