Key result
Incidental coronary calcium on non-gated chest CT is linked to ~3.2-fold higher MACE risk.
Why the study?
Studies linking incidental coronary artery calcium on chest CT to MACE have been limited to outpatients, leaving its prognostic utility among hospital inpatients undetermined.
Does incidentally identified coronary artery calcium on non-contrast chest CT predict major adverse cardiac events in hospital inpatients without known coronary artery disease?
Cohort (n=280)
Assessor blinded to clinical outcomes
No
Does incidentally identified coronary artery calcium on non-contrast chest CT predict major adverse cardiac events in hospital inpatients without known coronary artery disease?
Hazard Ratio: 3.2 (95% CI 1.8–5.6)
p-value: p=<0.001
The incidental finding of coronary artery calcium on routine inpatient non-gated chest CT independently predicts medium-term adverse cardiac events, offering a low-cost opportunity for risk stratification and primary prevention.
Incidental CAC on non-gated inpatient CT may aid MACE risk stratification; extends observational CAC data but leaves open need for prospective intervention trials.
BACKGROUND: Coronary 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 RESULTS: Consecutive 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. CONCLUSION: Incidental 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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Yu et al. (2021) conducted a cohort in Hospital inpatients without known coronary artery disease (n=280). Incidentally identified coronary artery calcium (CAC) vs. No visible coronary artery calcium (CAC) was evaluated on Major adverse cardiac events (MACE), a composite of all-cause death, non-fatal myocardial infarction, unstable angina requiring revascularisation, congestive cardiac failure and cerebrovascular events (adjusted HR 3.2, 95% CI 1.8 to 5.6, p=<0.001). Incidentally identified visible coronary artery calcium on non-gated chest CT was independently associated with a significantly increased risk of major adverse cardiac events (adjusted HR 3.2).
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