Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a retrospective cohort study

Abstract

To assess coronary artery calcification (CAC) and vascular calcification in patients with pulmonary embolism (PE) and correlate this with mortality. MATERIALS AND METHODS: PE severity was quantified using computed tomography pulmonary angiography (CTPA) in 400 consecutive cases using the modified Miller score (1e5, mild; 6e11, moderate; 12e16, severe). Right ventricle strain was assessed using the right/left ventricle diameter (RV/LV) ratio. CAC score (CACS) was assessed using a four-point scale (CACS mild 1e3, moderate 4e8, severe 9e12) for each vessel and summed to give the total CACS. Follow-up for mortality was obtained at 3 years. RESULTS: PE severity was classified as mild in 48%, moderate in 21%, and severe in 32% of cases. The median modified Miller score was 6 (Interquartile range [IQR] 2, 14) and median total CACS was 2 (IQR 0, 7). All-cause mortality occurred in 128 (32%) patients. Patients with CAC were three times more likely to die than patients without CAC (Hazard ratio [HR] 2.96; 95% CI 1.84, 4.77; p<0.001), and patients with severe CAC were at the highest risk (HR 4.62; 95% CI 2.73, 7.83, p<0.001). Gender, modified Miller score and RV/LV ratio were not predictive of mortality. In multivariate analysis both CACS and age were independent predictors of 3-year all-cause mortality. Of the patients with CAC who died, the presence of coronary artery disease was only documented in 34 (32%). CONCLUSION: CACS is an independent predictor of all-cause mortality in patients with PE, and has important implications for subsequent patient management.

Clinical and radiological characteristics of acute pulmonary embolus in relation to 28-day and 6-month mortality

“…Coronary artery calcification is a frequent incidental finding on CTPA, however radiologists infrequently report CTPA coronary artery calcification score when reporting scans performed for the investigation of suspected PE [ 4 , 21 ]. Williams et al .…”

“…Williams et al . have recently reported that the presence of coronary artery calcification identified on CTPA is a more important predictor of all-cause 3-year mortality than the severity of PE [ 21 ]. In their cohort, patients with severe calcification were reported to be almost five-times more likely to die at 3-years when compared to patients without coronary artery calcification [ 21 ].…”

“…have recently reported that the presence of coronary artery calcification identified on CTPA is a more important predictor of all-cause 3-year mortality than the severity of PE [ 21 ]. In their cohort, patients with severe calcification were reported to be almost five-times more likely to die at 3-years when compared to patients without coronary artery calcification [ 21 ]. To the best of our knowledge, the results of the present study are the first to report an association between coronary artery calcification and 28-day and 6-month mortality in patients with acute PE.…”

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

“…Patients undergoing CT for suspected PE are more likely to have coronary artery calcifications [38]. Few studies in the literature have investigated the importance of coronary artery calcifications on both short-and long-term mortality in patients with APE [39,40]. Ng et al, in their study of 1023 patients diagnosed with PE, showed that long-term all-cause cardiovascular mortality was 2.2 higher than in patients without cardiovascular diseases [41].…”

Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI/BSCCT and BSTI

“…Recommendations for the assessment of cardiac calcification on routine thoracic CT Coronary artery calcification on non-gated thoracic CT CAC can be identified on non-gated thoracic CT with an excellent diagnostic accuracy compared to gated CT. 25,26 However, CAC is frequently not reported on non-gated thoracic CT, [27][28][29][30] and a recent survey demonstrated only 17% of noncardiothoracic radiologists in Canada were aware of the correlation between CAC scores on gated and non-gated thoracic CT. 31 The incidence of CAC on non-gated thoracic CT performed for non-cardiac indications varies from 26 to 93% depending on the population assessed. [28][29][30][32][33][34] It is associated with poorer prognosis in a variety of patient cohorts including patients with chronic obstructive pulmonary disease, pulmonary embolism, cancer and in unselected patients undergoing thoracic CT. 32,[35][36][37][38][39] In the National Lung Screening Trial, CAC was associated with an increased risk of coronary artery disease-related death, with a CAC score of 100-1000 AU associated with a fourfold increase, and CAC score of >1000 AU associated with a sevenfold increase compared to patients without CAC. 35 Reporting coronary calcification While conventional Agatston scoring remains the gold-standard assessment, it requires dedicated software and training.…”