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

Abstract

Purpose: Coronary artery calcium (CAC) is a frequent incidental finding on computed tomography pulmonary angiogram (CTPA) in the evaluation of pulmonary embolism (PE) in the emergency department (ED); however, its prognostic value is unclear. In this study, we interrogate the prognostic value of CAC identified on CTPA in predicting adverse outcomes in the evaluation of PE in the ED. Materials and Methods:In this retrospective cohort study, we identified 610 patients presenting to the ED in 2013 and evaluated with CTPA for suspected PE. Ordinal CAC scores were evaluated as absent (0), mild (1), moderate (2), or severe (3) in each of the 4 main coronary arteries. Composite CAC scores were subsequently compared against adverse clinical outcomes, defined as intensive care unit admission, hospital stay longer than 72 hours, or death during hospital course or at 6-month follow-up, using univariate and multivariate logistic regression analyses. Relevant exclusion criteria included a history of cardiovascular disease.Results: In all, 365 patients met the inclusion criteria (231 women, mean age 56 ± 16 y) with 132 patients (36%) having some degree of CAC and 16 (4%) having severe CAC. Known malignancy was present in 151 (41%) patients and composite adverse clinical outcomes were observed in 98 patients (32%). Age, presence of acute PE, malignancy, and presence of CAC were significant predictors of adverse outcomes on both univariate and multivariate analyses. CAC was not an independent predictor of short-term adverse outcomes on multivariate analysis (P = 0.06) when all patients were considered. However, when patients with known malignancy were excluded, CAC was an independent predictor of short-term adverse outcomes (odds ratio = 2.5, confidence interval = 1.1-5.5, P = 0.03) independent of age and presence of PE. Conclusion:The presence of CAC on CT PA was predictive of adverse outcomes in patients without known cardiac disease presenting to the ED with suspected PE.

Value of computed tomography pulmonary angiography measurements in predicting 30-day mortality among patients with acute pulmonary embolism

“…Furthermore, a CACS of ≥ 6 has been associated with higher 28-day and 6-month mortality, and CACS ≥ 6 remained independently associated with death at 6 months. In the study of Vakil et al [ 29 ], the presence of CAC was a significant predictor of adverse outcomes during admission (ICU admission, prolonged hospitalisation, or death) and after 6 months, particularly when patients with malignancies were excluded. Similarly, in the study by Albay et al [ 8 ], there was a significant relationship between increased CACS and increased mortality.…”

Opportunistic screening at chest computed tomography: literature review of cardiovascular significance of incidental findings

“…CAC on contrast-enhanced CT was associated with MACE with a hazard ratio of 4.5 ( 31 ). CAC detected on CT pulmonary angiography has been shown to be an independent predictor of short-term adverse outcomes in patients without known cardiac disease ( 32 ).…”

Radiation Dose Reduction for Coronary Artery Calcium Scoring Using a Virtual Noniodine Algorithm on Photon-Counting Detector Computed-Tomography Phantom Data

“…Coronary artery calcium scoring (CACS) is a strong predictor of future adverse cardiovascular events and outcomes [1][2][3][4][5], and is thereby used for cardiovascular risk stratification [6,7]. The cardiac computed tomography (CT)-based Agatston method (tube voltage, 120 kVp; reconstruction with slice thickness, 3.0 mm) with a threshold of 130 Hounsfield Diagnostics 2023, 13, 1540 2 of 13 units (HU) is considered the standard method for CACS [8].…”