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Coronary artery calcium indentified on non-gated chest CT scans - a wasted opportunity to avoid the tragedy
Session:
Comunicações Orais - Sessão 29 - Score cálcio coronário
Speaker:
Beatriz Valente Silva
Congress:
CPC 2023
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Beatriz Valente Silva; Miguel Nobre Menezes; Rui Plácido; Cláudia Jorge; Joana Rigueira; Joana Brito; Pedro Alves da Silva; Catarina Oliveira; Ana Margarida Martins; Beatriz Garcia; Ana Abrantes; João Fonseca; Miguel Raposo; Catarina Gregório; Ana Almeida; Fausto J Pinto
Abstract
<p style="text-align:justify"><strong>Introduction</strong>: Coronary artery calcium (CAC) is an independent predictor of cardiovascular events. While it is traditionally performed utilizing gating with specific acquisition parameters, CAC can be identified in non-gated standard chest computed tomography (CT). This study aimed to assess CAC on chest CTs, evaluating its correlation with coronary lesions on coronary angiography (CAG) and prognosis.</p> <p style="text-align:justify"><strong>Methods</strong>: We retrospectively reviewed patients (pts) who underwent CAG due to acute coronary syndrome (ACS) who had undergone a prior non-gated non-contrast chest CT. CAC was qualitatively evaluated by visual assessment (mild/moderate/severe) and quantitatively assessed using Agatson score and stratified by terciles. Evaluation was performed by an investigator blinded to CAG report.</p> <p style="text-align:justify"><strong>Results</strong>: We included 114 pts after reviewing 1000 CAGs: 67% male, mean age 68 years, 78% hypertension, 62% dyslipidemia, 38% chronic kidney disease, 38% diabetes. The mean time difference between CT and CAG was 23 months. CAG was performed due to unstable angina in 33% of pts, NSTEMI in 52% and STEMI in 16%. Significant lesions were found in 57% (69% performed PCI and 17% surgical revascularization).</p> <p style="text-align:justify">CAC was visual classified as mild, moderate and severe in 31%, 33% and 16% of pts, respectively. Moderate or severe CAC was an independent predictor of significant lesions on CAG [OR 22, 95%CI 8-61, p<0.001] and all-cause mortality [OR 4, 95%CI 2-9, p=0.001]. Pts with severe CAC had higher peak troponin than those with mild/moderate CAC (1780 vs 315 ng/L, p=0.024).</p> <p style="text-align:justify">Quantitative CAC score accurately predicted significant lesions (AUC 0.81, p<0.001; figure 1A), with higher scores in this subgroup (1308 vs 120, p<0.001) and strongly correlated with SYNTAX score (p<0.001).</p> <p style="text-align:justify">Survival analysis stratified by severity of CAC assessment is shown in figure 1B and 1C.</p> <p style="text-align:justify">The most severely calcified artery in the CT often matched the culprit vessel of future ACS, with 79%, 60% and 50% concordance for left anterior descending, circumflex, and right coronary artery, respectively.</p> <p style="text-align:justify">While significant CAC was identified in 80% of CTs, formal reporting was as low as 25%, even with severe CAC, where only 2/18 reports mentioned it. Furthermore, only 62% pts were on statin therapy at the time of CAG.</p> <p style="text-align:justify"><strong>Conclusion</strong>: CAC evaluation in chest CTs was feasible and strongly associated with the extent/severity of coronary artery disease on CAG, as well as mortality. Notwithstanding, CAC underreporting was frequent and statin therapy underused, suggesting a simple and common opportunity for preventive care.</p>
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