BackgroundCoronary artery calcium (CAC) identified on non-gated CT scan of the chest is predictive of major adverse cardiac events (MACE) in multiple studies with guidelines therefore recommending the routine reporting of incidental CAC. These studies have been limited however to the outpatient setting. We aimed to determine the prognostic utility of incidentally identified CAC on CT scan of the chest among hospital inpatients.Methods and resultsConsecutive patients (n=740) referred for inpatient non-contrast CT scan of the chest at a tertiary referral hospital (January 2011 to March 2017) were included (n=280) if they had no known history of coronary artery disease, active malignancy or died within 30 days of admission. Scans were assessed for the presence of CAC by visual assessment and quantified by Agatston scoring. Median age was 69 years (IQR: 54–82) and 51% were male with a median CAC score of 7 (IQR 0–205). MACE occurred in 140 (50%) patients at 3.5 years median follow-up including 98 deaths. Half of all events occurred within 18 months. Visible CAC was associated with increased MACE (HR) 6.0 (95% CI: 3.7 to 9.7) compared with patients with no visible CAC. This finding persisted after adjusting for cardiovascular risk factors HR 2.4 (95% CI: 1.3 to 4.3) and with both absolute CAC score and CAC score ≥50th percentile.ConclusionIncidental CAC identified on CT scan of the chest among hospital inpatients provides prognostic information that is independent of cardiovascular risk factors. These patients may benefit from aggressive risk factor modification given the high event rate in the short term.

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Background: The underlying aetiology in patients presenting with myocardial infarction and non-obstructive coronary arteries (MINOCA) is varied and has important implications for treatment and prognosis. Cardiac MRI (CMRI) may help clarify the underlying cause in MINOCA. We aimed to evaluate the diagnostic utility of CMRI in this setting. Methods: 995 consecutive patients referred to a tertiary referral hospital for CMRI (January 2016-December 2019) were screened. Patients meeting the Fourth Universal Definition of Myocardial Infarction without obstructive coronary artery disease (50% stenosis) were included. The underlying cause of MINOCA was determined using standard CMRI criteria and peak high-sensitivity troponin T (HsTropT) compared among patients with and without a CMRI diagnosis. Results: 46 MINOCA cases were identified (52.2615.5 years, 59% male). CMRI was normal in 16/46 (35%) patients. Among the 30/46 (65%) patients with an abnormal CMRI, diagnoses included myopericarditis (14/46, 30%), myocardial infarction (8/46, 17%), Takotsubo (5/46, 11%) and hypertrophic (3/46, 7%) cardiomyopathy. Median HsTropT was 343 (117-713) ng/L overall but significantly lower in patients with a normal CMR (129 (26-343) vs 590 (203-1367) ng/L, p=0.0002). HsTropT had high diagnostic accuracy for predicting a CMRI abnormality by ROC analysis (AUC 0.83, p=0.004). A HsTropT value .262ng/L was 71% sensitive and 73% specific for predicting an abnormal CMRI and all patients with a HsTropT .637ng/L had an abnormal CMRI. Conclusion: Patients with MINOCA are a heterogenous cohort and CMRI identifies a cause in almost two-thirds of cases. Peak HsTropT may help guide selection of MINOCA patients for CMRI referral.

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