Coronary Artery Calcium Can Predict All-Cause Mortality and Cardiovascular Events on Low-Dose CT Screening for Lung Cancer

OBJECTIVES: Performing coronary artery calcium (CAC) screening as part of low-dose CT lung cancer screening has been proposed as an efficient strategy to detect people with high cardiovascular risk and improve outcomes of primary prevention. This study aims to investigate whether CAC measured on low-dose CT in a population of former and current heavy smokers is an independent predictor of all-cause mortality and cardiac events.

METHODS:We used a case-cohort study and included 958 subjects 50 years old or older within the screen group of a randomized controlled lung cancer screening trial. We used Cox proportional-hazard models to compute hazard ratios (HRs) adjusted for traditional cardiovascular risk factors to predict all-cause mortality and cardiovascular events.

RESULTS: During a median follow-up of 21.5 months, 56 deaths and 127 cardiovascular events occurred. Compared with a CAC score of 0, multivariate-adjusted HRs for all-cause mortality for CAC scores of 1-100, 101-1000, and more than 1000 were 3.00 (95% CI, 0.61-14.93), 6.13 (95% CI, 1.35-27.77), and 10.93 (95% CI, 2.36-50.60), respectively. Multivariate-adjusted HRs for coronary events were 1.38 (95% CI, 0.39-4.90), 3.04 (95% CI, 0.95-9.73), and 7.77 (95% CI, 2.44-24.75), respectively.

CONCLUSIONS: This study shows that CAC scoring as part of low-dose CT lung cancer screening can be used as an independent predictor of all-cause mortality and cardiovascular events. Andre Smith Authentic Jersey

PMID: 22357989

Posted in Computed Tomography and tagged , , , , , , , .

4 Comments

  1. From the same group:

    Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers.
    Jacobs PC, Prokop M, van der Graaf Y, Gondrie MJ, Janssen KJ, de Koning HJ, Isgum I, van Klaveren RJ, Oudkerk M, van Ginneken B, Mali WP.
    Atherosclerosis. 2010 Apr;209(2):455-62.
    PMID: 19875116 []

  2. I would advocate gating low-dose chest CT screening studies, but I would be worried that scoring a non-gated study would be putting a “stamp” of a calcium score on a patient that might not be accurate. I see many *gated* calcium scores that miss calcified plaques (due to artifact, small jumps, etc.) subsequently present on a coronary CTA. For incredibly high calcium scores, obviously does not matter as much, but harder to follow these patients over time with accuracy. It would be interesting to see if a qualitative judgment (no calcium, mild calcium, moderate calcium, severe calcium) would correlate well with MACE.

  3. See also:

    Detection of coronary calcium during standard chest computed tomography correlates with multi-detector computed tomography coronary artery calcium score.
    Kirsch J, Buitrago I, Mohammed TL, Gao T, Asher CR, Novaro GM.
    Int J Cardiovasc Imaging. 2011 Aug 11.
    PMID: 21833776 http://www.ncbi.nlm.nih.gov/pubmed/21833776

  4. Juan,
    One other concern that I would have with gated studies for ‘lung screening’ is that the lungs don’t look as pristine as on non-gated studies (less mis-registration from minimal changes in lung volumes?).

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