Incidental coronary artery calcification on non-gated CT thorax correlates with risk of cardiovascular events and death

• Published in: European radiology Vol. 33; no. 7; pp. 4723 - 4733
• Main Authors: Wetscherek, Maria T. A., McNaughton, Edwina, Majcher, Veronika, Wetscherek, Andreas, Sadler, Timothy J., Alsinbili, Ahmed, Teh, Wen Hui, Moore, Samuel D., Patel, Nirav, Smith, William P. W., Krishnan, Unni
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2023; Springer Nature B.V
• Subjects: Arteriosclerosis; Atherosclerosis; Calcification; Calcification (ectopic); Cardiovascular diseases; Cerebral infarction; Chest; Coronary artery; Coronary vessels; Correlation; Death; Diabetes mellitus; Diagnostic Radiology; Dyslipidemia; EKG; Genetics; Health hazards; Health risks; Heart diseases; Hypertension; Imaging; Internal Medicine; Interventional Radiology; Ischemia; Medicine; Medicine & Public Health; Mortality; Myocardial infarction; Neuroradiology; Radiology; Risk factors; Smoking; Statistical analysis; Subgroups; Thorax; Ultrasound; Computed tomography; Coronary artery calcification; Preventative cardiology
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-09428-z

Objectives
To assess coronary artery calcification (CAC) on non-contrast non-ECG-gated CT thorax (NC-NECG-CTT) and to evaluate its correlation with short-term risk of cardiovascular disease (CVD) events and death.
Methods
Single-institution retrospective study including all patients 40–70 years old who underwent NC-NECG-CTT over a period of 6 months. Individuals with known CVD were excluded. The presence of CAC was assessed and quantified by the Agatston score (CACS). CAC severity was defined as mild (< 100), moderate (100–400), or severe (> 400). CVD events (including CVD death, myocardial infarction, revascularisation procedures, ischaemic stroke, acute peripheral atherosclerotic ischaemia), and all-cause mortality over a median of 3.5 years were recorded. Cox proportional-hazards regression modelling was performed including CACS, age, gender and CVD risk factors (smoking, hypertension, diabetes mellitus, dyslipidaemia, and family history of CVD).
Results
Of the total 717 eligible cases, 325 (45%) had CAC. In patients without CAC, there was only one CVD event, compared to 26 CVD events including 5 deaths in patients with CAC. The presence and severity of CAC correlated with CVD events (
p
 < 0.001). A CACS > 100 was significantly associated with both CVD events, hazard ratio (HR) 5.74, 95% confidence interval: 2.19–15.02;
p
 < 0.001, and all-cause mortality, HR 1.7, 95% CI: 1.08–2.66;
p
 = 0.02. Ever-smokers with CAC had a significantly higher risk for all-cause mortality compared to never-smokers (
p
 = 0.03), but smoking status was not an independent predictor for CVD events in any subgroup category of CAC severity.
Conclusions
The presence and severity of CAC assessed on NC-NECG-CTT correlates with short-term cardiovascular events and death.
Key Points
• Patients aged 40–70 years old without known CVD but with CAC on NC-NECG-CTT have a higher risk of CVD events compared to those without CAC.
• CAC (Agatston) score above 100 confers a 5.7-fold increase in the risk of short-term CVD events in these patients.
• The presence and severity of CAC on NC-NECG-CTT may have prognostic and therapeutic implications.