Department of Cardiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
Open Heart. 2021 Oct;8(2). doi: 10.1136/openhrt-2021-001695.
Coronary artery calcium (CAC) identified on non-gated CT scan of the chest is predictive of major adverse cardiac events (MACE) in multiple studies with guidelines therefore recommending the routine reporting of incidental CAC. These studies have been limited however to the outpatient setting. We aimed to determine the prognostic utility of incidentally identified CAC on CT scan of the chest among hospital inpatients.
Consecutive patients (n=740) referred for inpatient non-contrast CT scan of the chest at a tertiary referral hospital (January 2011 to March 2017) were included (n=280) if they had no known history of coronary artery disease, active malignancy or died within 30 days of admission. Scans were assessed for the presence of CAC by visual assessment and quantified by Agatston scoring. Median age was 69 years (IQR: 54-82) and 51% were male with a median CAC score of 7 (IQR 0-205). MACE occurred in 140 (50%) patients at 3.5 years median follow-up including 98 deaths. Half of all events occurred within 18 months. Visible CAC was associated with increased MACE (HR) 6.0 (95% CI: 3.7 to 9.7) compared with patients with no visible CAC. This finding persisted after adjusting for cardiovascular risk factors HR 2.4 (95% CI: 1.3 to 4.3) and with both absolute CAC score and CAC score ≥50th percentile.
Incidental CAC identified on CT scan of the chest among hospital inpatients provides prognostic information that is independent of cardiovascular risk factors. These patients may benefit from aggressive risk factor modification given the high event rate in the short term.
在多项研究中，非门控胸部 CT 扫描发现的冠状动脉钙（CAC）可预测主要不良心脏事件（MACE），因此指南建议常规报告偶然发现的 CAC。然而，这些研究仅限于门诊环境。我们旨在确定住院患者胸部 CT 扫描中偶然发现的 CAC 的预后价值。
连续患者（n=740）在三级转诊医院接受住院非对比胸部 CT 扫描（2011 年 1 月至 2017 年 3 月），如果他们没有已知的冠心病、活动性恶性肿瘤病史或在入院后 30 天内死亡，则包括在内（n=280）。通过视觉评估评估扫描是否存在 CAC，并通过 Agatston 评分进行定量评估。中位年龄为 69 岁（IQR：54-82），51%为男性，中位 CAC 评分为 7（IQR 0-205）。中位随访 3.5 年时，140 例（50%）患者发生 MACE，包括 98 例死亡。所有事件中有一半发生在 18 个月内。与无可见 CAC 的患者相比，可见 CAC 与 MACE 增加相关（HR）6.0（95%CI：3.7 至 9.7）。调整心血管危险因素后，这一发现仍然存在（HR 2.4，95%CI：1.3 至 4.3），并且与绝对 CAC 评分和 CAC 评分≥第 50 百分位均相关。
在住院患者的胸部 CT 扫描中偶然发现的 CAC 提供了独立于心血管危险因素的预后信息。鉴于短期内高事件发生率，这些患者可能受益于积极的危险因素修正。
