Key result
In emergency room and hospitalized patients, higher coronary artery calcification burden assessed by the Weston score on non-gated chest CT independently predicted major adverse cardiac events (HR 1.30).
Why the study?
Coronary artery calcification provides insight into CAD risks to influence early intervention, and visual scoring by the Weston method on non-gated CT scans could quickly provide CAC information for triage and management.
Does coronary artery calcification scoring using the Weston Method predict major adverse cardiac events in emergency room or hospitalized patients?
Cohort (n=493)
Blinded to demographic and clinical data
No
Does coronary artery calcification scoring using the Weston Method predict major adverse cardiac events in emergency room or hospitalized patients?
Hazard Ratio: 1.3 (95% CI 1.16–1.45)
p-value: p=<0.0001
Semi-quantitative assessment of coronary artery calcification using the Weston score on non-gated chest CTs independently predicts long-term MACE and mortality in hospitalized patients.
Visual Weston CAC scoring on non-gated CT may aid routine risk triage; leaves open prospective outcome validation before practice change.
Background: Coronary artery calcification (CAC) may provide insight to the patients' coronary artery disease (CAD) risks and influence early intervention. With increasing use of non-gated CT scans in clinical practice, the visual coronary artery scoring system (Weston Method) could quickly provide clinicians with important information of CAC for patient triage and management. Methods: We retrospectively studied the available CT imaging data and estimated CAC burden using the Weston method in 493 emergency room or other hospitalized patients. The Weston scores were calculated by the sum of the score for each vessel including the left main, left anterior descending, left circumflex artery and right coronary artery (range 0–12). The primary endpoint was a composite of the major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, stroke, and coronary revascularization. Results: During a median follow-up of 85 months, a total of 25 (5.1%) MACE were recorded and 57 (11.2%) patients died from any causes. Detectable CAC was most common (96%) in the left anterior descending coronary arteries. Multivariable analysis showed that CAC total scores were independent predictors for MACE and all-cause mortality. Receiver operating characteristic analysis showed that CAC total score ≥5 was the optimal cutoff value for predicting MACEs. Conclusions: In the emergency room and hospitalized patients, the semi-quantitation of CAC burden using the Weston score system was related to the long-term cardiovascular outcomes including mortality. Clinicians and radiologists should maximize the value of non-contrast chest CT images by reporting CAC details.
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Chen et al. (2021) conducted a cohort in Emergency room or hospitalized patients undergoing non-contrast chest CT (n=493). Coronary artery calcification total score (Weston method) vs. Lower CAC score was evaluated on Composite of major adverse cardiac events (MACEs), including cardiac death, non-fatal myocardial infarction, non-fatal stroke, and coronary revascularization (HR 1.30, 95% CI 1.16-1.45, p=<0.0001). In emergency room and hospitalized patients, higher coronary artery calcification burden assessed by the Weston score on non-gated chest CT independently predicted major adverse cardiac events (HR 1.30).
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