Coronary or thoracic artery calcium score in provoked and unprovoked pulmonary embolism: a case‐control study

Abstract

To cite this article: van der Bijl N, Klok FA, Huisman MV, Roos de A, Kroft LJM. Coronary or thoracic artery calcium score in provoked and unprovoked pulmonary embolism: a case-control study. J Thromb Haemost 2016; 14: 931-5. Essentials• Patients with unprovoked pulmonary embolism (PE) are at increased risk of arterial thromboembolism.• Coronary and thoracic aorta calcium were evaluated in patients with and without (unprovoked) PE.• No association was found between (unprovoked) PE and coronary or aortic calcification.• Assessment of both calcium scores on computed tomography pulmonary angiography was highly reproducible.Summary. Objective: To evaluate the potential association between (unprovoked) pulmonary embolism (PE) and the presence and extent of coronary artery calcium (CAC) and thoracic aorta calcium (TAC). Methods: CAC and TAC derived from computed tomography pulmonary angiography of 100 patients with PE were compared to that of 100 patients in whom PE was ruled out. Results: Intraobserver and interobserver agreements for both TAC and CAC were excellent (intraclass correlation > 0.95 for both). In patients with PE vs. patients without PE, no significant differences were found in the presence of CAC or TAC (CAC 64% vs. 67%, odds ratio [OR] 1.0, 95% confidence interval [CI] 0.67-1.6; TAC 46% vs. 59%, OR 1.2, 95% CI 0.80-2.1). Mean CAC and TAC scores were significantly lower in patients with PE than in patients without PE (CAC 3.4 vs. 4.9, absolute difference 1.5, 95% CI 0.2-2.8; TAC 1.1 vs. 1.8, absolute difference 0.9, 95% CI 0.2-1.2). No significant differences were found in the presence of CAC or TAC or in mean CAC and TAC scores between patients with unprovoked PE vs.patients with provoked PE, or between patients with unprovoked PE vs. no PE. Conclusion: No significant differences were found between the extent of CAC and TAC in patients with unprovoked PE compared to those with provoked PE or without PE. The observed difference in the extend of CAC and TAC between patients with and without PE was dependent on prevalent cardiovascular risk factors.

Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a retrospective cohort study

“…This is similar to the frequency identified in previous cohorts. 26,27 After 3 years of follow-up, CAC and age were the only independent predictors of mortality. This suggests that if patients survive the early haemodynamic effects of PE and receive appropriate treatment, the subsequent prognosis depends more on comorbidities than the severity of the initial PE.…”

Ordinal Scoring of Coronary Artery Calcification by Computed Tomography Pulmonary Angiography in Acute Pulmonary Embolism

“…Our study is one of the few in the literature to evaluate coronary artery atherosclerosis in PE patients 6–10 . This retrospective study investigated the ability of CTPA to establish a PE diagnosis, simultaneously assess RVD and CAC, and predict severe clinical deterioration.…”

“…Coronary artery calcification was present in 148 (44.8%) patients, which means that coronary artery atherosclerosis is common among patients with PE. Previous studies have reported frequencies of CAC ranging from 44% to 68% 6–10 …”

“…Our study is one of the few in the literature to evaluate coronary artery atherosclerosis in PE patients. [6][7][8][9][10] This retrospective study investigated the ability of CTPA to establish a PE diagnosis, simultaneously assess RVD and CAC, and predict severe clinical deterioration. Coronary artery calcification was present in 148 (44.8%) patients, which means that coronary artery atherosclerosis is common among patients with PE.…”

Predictive Value of Coronary Artery Calcium in Patients Receiving Computed Tomography Pulmonary Angiography for Suspected Pulmonary Embolism in the Emergency Department

“…CAC was estimated using an ordinal visual scale by a cardiothoracic imaging radiologist with 10 years of experience, blinded to the outcomes. This method was originally described and validated by Shemesh et al 14 on nongated low-dose CT lung cancer screening studies, has been previously applied in contrast and noncontrast ECG-gated and non-ECG-gated studies, 13,[21][22][23] can be performed on standard images with no additional reconstructions performed, and found to have high interobserver reproducibility and strong agreement with gold standard Agatston scoring. 24 Left main, left anterior descending, circumflex, and right main were considered as 4 main coronary arteries on CTPA.…”