Impact of Significant Coronary Artery Calcification Reported on Low-Dose Computed Tomography Lung Cancer Screening

Abstract

Background: Coronary artery calcification (CAC) is a common and important incidental finding in low-dose computed tomography (LDCT) performed for lung cancer screening (LCS). The impact of these incidental findings on patient management is unclear. Purpose: The goals of our study were to determine the impact of reporting CAC on patient management and to determine whether standardized reporting of CAC affects the likelihood of future interventions. Methods: In this IRB-approved retrospective study, we queried our LCS database for reports of LDCT performed between January 2016 and September 2018. All reports with significant findings of CAC designated with the letter “S” for any Lung-RADS category were selected. The grading of CAC was extracted from the reports. Medical records were reviewed for each patient to determine demographics, clinical history, medications, and cardiac-related diagnostic and interventional procedures. The changes in management after the report of significant CAC on LDCT were documented. Statistical analysis with Student t test and Pearson χ2 test was performed. Results: A total of 756/3110 patients (mean age: 67±6.4 y; M=466, 61.6%: F=290, 38.4%) were reported to have significant CAC on LDCT for LCS. Of them, 236/756 patients (31.2%) had established coronary artery disease (CAD) at baseline, before the initial LDCT. A change in management was observed in 155/756 patients (20.5%). The most common changes in management included the following: alteration in medication regimen (n=114/155, 73.5%), stress testing (n=65/155, 41.9%), and referral to a cardiologist (36/155, 23.2%). Percutaneous coronary intervention (4, 2.6%) and surgery (3, 1.9%) were uncommon. Changes in management were more common in those without established CAD and in those whose CAC was semiquantitatively graded (35% vs. 25%, P=0.02). Conclusion: CAC is a common significant finding in LDCT for LCS. Reporting of CAC in patients with nonestablished CAD and semiquantitative assessment resulted in changes in management.

Coronary artery calcification in COVID-19 patients: an imaging biomarker for adverse clinical outcomes

“…NCCTs are sometimes performed on hospitalized COVID-19 patients for various reasons; therefore, visual CAC scoring does not require additional imaging assessment but can provide useful prognostic data [36]. Although CAC is an established imaging marker for predicting cardiovascular event risk, CAC reporting incidence may be as low as 1% [36,37].…”

“…NCCTs are sometimes performed on hospitalized COVID-19 patients for various reasons; therefore, visual CAC scoring does not require additional imaging assessment but can provide useful prognostic data [36]. Although CAC is an established imaging marker for predicting cardiovascular event risk, CAC reporting incidence may be as low as 1% [36,37]. CAC on NCCT may be the first evidence of undiagnosed CAD and may be a more objective and dependable means of rapid risk stratification in COVID-19 patients, unaffected by confounding variables such as recall bias that may occur during history taking.…”

Lung cancer screening implementation: Complexities and priorities

“…Coronary artery calcification is commonly detected in lung cancer screened participants and increasing severity of disease is associated with increasing risk of cardiovascular events and allcause mortality. [151][152][153][154][155] A screening LDCT can also identify the presence of emphysema as well as vertebral fractures and osteoporosis which are independently associated with increased all-cause mortality. 156,157 LDCT chest scans, utilized for lung cancer screening, can therefore be used to evaluate the presence of other undiagnosed comorbidities that are predictive of increased all-cause mortality, providing a potential opportunity to further improve health outcomes.…”

“…High‐risk screening participants are at risk of other comorbidities that contribute to increased mortality such as cardiovascular disease and chronic obstructive pulmonary disease. Coronary artery calcification is commonly detected in lung cancer screened participants and increasing severity of disease is associated with increasing risk of cardiovascular events and all‐cause mortality 151–155 . A screening LDCT can also identify the presence of emphysema as well as vertebral fractures and osteoporosis which are independently associated with increased all‐cause mortality 156,157 .…”

Preoperative coronary artery calcifications in veterans predict higher all-cause mortality in early-stage lung cancer: a cohort study

“…More recently, CAC scores have also been shown to be independent predictors of all-cause mortality and of fatal and non-fatal cardiac events in several lung cancer screening populations, including the National Lung Screening Trial (NLST) and the Danish Lung Cancer Screening Trial (10)(11)(12)(13)(14)(15). As many as half of patients undergoing lung cancer screening had CAC incidentally found on computed tomography (CT) scans, while fewer than one-third of these patients carried a pre-screening diagnosis of CAD (16,17). In the NLST population, 50% of deaths were related to cardiovascular events, and CAC identified on screening CT scans were a very high predictor of major cardiovascular events and mortality even without a prior diagnosis of CAD (13,18,19).…”