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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Association of Quantitative Coronary Artery Calcium Density Subtype Volumes With Major Adverse Cardiovascular Events
Donghee Han1, Aakash Shanbhag2, Jianhang Zhou1
1Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Background:
Growing evidence has demonstrated that low density coronary artery calcification (CAC) is associated with a higher risk of cardiovascular events.
Objectives:
We aim to explore the relationship between CAC volumes at predefined densities, assessed by CAC volume according to CAC Hounsfield unit (HU), and major adverse cardiac events (MACEs).
Methods:
We evaluated 3 patient groups with no prior coronary artery disease history who underwent an electrocardiogram-gated noncontrast computed tomography scan for CAC scanning (CAC group, n = 2,028) or as part of a cardiac imaging test: single-photon emission computed tomography (SPECT)-myocardial perfusion imaging (SPECT group, n = 2,782), and positron emission tomography (PET)-myocardial perfusion imaging (PET group, n = 2,366). CAC subtype volumes of low, intermediate, and high density based on HU cutoff (low: 130-199 HU, intermediate: 200-399 HU, and high: ≥400 HU). MACE included mortality, myocardial infarction, unstable angina, and late revascularization.
Results:
During a median 4.3 years (interquartile ranges: 2.6-12.8) follow-up duration, 1,033 MACE occurred (14.4%). In multivariable analysis, low-density CAC volume was independently predictive of MACE (log-transformed; CAC group: HR: 1.65; 95% CI: 1.05-2.60; SPECT group: HR: 1.41, 95% CI: 1.02-1.94; PET group: HR: 1.34, 95% CI: 1.11-1.61; P < 0.05), whereas intermediate and high-density volumes were not (P > 0.05). Density CAC volumes improved discrimination and reclassification among all 3 groups (CAC, SPECT, and PET groups: global chi-square improvement: 9.1, 16.1, and 16.6, respectively, P < 0.01; net reclassification index: 47.3, [95% CI: 33.2-61.4], 49.6 [95% CI: 36.8-62.4] and 15.4, [95% CI: 5.9-24.9], respectively, P < 0.01).
Conclusions:
Low-density HU volume was independently associated with an increased MACE risk and improved discrimination and reclassification over conventional approaches in a broad spectrum of individuals undergoing CAC scanning.
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