SPC365

Calcium hides the clue: Unraveling the diagnostic value of early Coronary Calcium Scoring in Cardiac Arrest Survivors

Session: Sessão de Posters 04 - Choque cardiogénico
Speaker: Ana Margarida Martins

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.5 Acute Cardiac Care – Cardiac Arrest
Session Type: Cartazes
FP Number: ---
Authors: Ana Margarida Martins; Ana Beatriz Garcia; Catarina Oliveira; Ana Abrantes; Miguel Raposo; Catarina Gregório; Beatriz Valente Silva; Joana Rigueira; Rui Plácido; Doroteia Silva; Fausto J.Pinto; Ana Almeida

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Prognosis for out-of-hospital cardiac arrest (OHCA) remains dismal, with a mortality rate of up to 65%, even among patients (pts) who undergo successful resuscitation. Acute coronary syndrome (ACS) is a major cause of OHCA, but the benefits of early coronary angiography (CA) in resuscitated pts without STEMI are increasingly debated. Coronary artery calcium (CAC) is a predictor of CV events and is commonly assessed through cardiac CT with ECG gating. Notably, standard chest CT scans as those performed for etiologic study of cardiac arrest, can also reveal CAC. </span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Aim</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">To find if CAC detected in non-gated CT scans performed in OHCA survivors could be a good predictor of coronary artery disease and help select those who effectively require CA. We also aimed to assess the rate of CAC reporting.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Single-center, retrospective study of OHCA survivors without STEMI. We selected those who performed a non-gated chest CT as a part of an etiological study and underwent CA due to clinical, ECG or echo suspicion of ACS. An investigator blinded to the CA report, evaluated CAC both quantitively (with Agatston score) and qualitatively (visual assessment: absent, mild, moderate or severe). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Results</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">A total of 45 pts were included, 71% male, mean age of 57</span><em><span style="font-family:&quot;Cambria Math&quot;,serif">&plusmn;</span></em><span style="font-family:&quot;Calibri&quot;,sans-serif">10 years old. 88,9% of the OHCA were witnessed, with mean no-flow time of 4</span><span style="font-family:&quot;Calibri&quot;,sans-serif">&plusmn;</span><span style="font-family:&quot;Calibri&quot;,sans-serif">7 mins and low-flow time of 18,3</span><span style="font-family:&quot;Calibri&quot;,sans-serif">&plusmn;</span><span style="font-family:&quot;Calibri&quot;,sans-serif">13,6 mins. Most pts presented with ventricular fibrillation or non-specified shockable rhythm (22,4% each). CT scans were performed with a mean of 3,7h after first medical contact. CAC was identified in 57,8% pts and classified as mild, moderate and severe in 19,2%, 42,3% and 38,4%, respectively. Mean Agatston score was 387</span><em><span style="font-family:&quot;Cambria Math&quot;,serif">&plusmn;</span></em><span style="font-family:&quot;Calibri&quot;,sans-serif">&nbsp;322UA. Only 16 pts showed significant coronary lesions in the CA (33,3% of pts), of which 80% had angioplasty and 2,2% CABG. The most frequent culprit vessel was the anterior descending artery.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Quantitative CAC assessment accurately predicted the presence of significant lesions on CA (AUC=0,873; 95%CI 0,773-0,974, p&lt;0,001) (Fig 1). In fact, of the 19 pts who showed a Agatston score of 0, none showed significant lesions on CA. The presence of moderate or severe CAC by visual assessment also predicted significant lesions on CA (OR 13,4 95% CI 1,755- 103,68, p=0,012). There was also a good and significant correlation between the vessel with at least moderate calcification in CT-scan (Agatston score &gt;100) and the vessel identified as culprit in CA (kappa=0,615, p&lt;0,001). The CAC was reported in only 7,7% CT exams, all with severe calcification.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Assessment of CAC in chest CT scans proved to be feasible and displayed a robust correlation with the presence, severity and location of CAD. Its routine use upfront showed to be an important complement to CT scans report, better directing patient care &ndash; avoiding time consuming invasive procedure and focusing on neuro-protection, the single most determinant prognostic factor in these patients.</span></span></span></p>