Chin John C, Maroules Christopher D, Lin Andrew H, Graning Rolf E, Pressley Cullen R
Naval Medical Center Portsmouth, Virginia.
Fed Pract. 2022 Sep;39(9):382-388. doi: 10.12788/fp.0318. Epub 2022 Sep 14.
Cigarette smoking is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Concomitant use of low-dose computed tomography (LDCT) for coronary artery calcium (CAC) scoring with lung cancer screening (LCS) has been proposed to further determine ASCVD risk and mortality. We aimed to determine the validity of LDCT in identifying CAC and its impact on statin management.
We conducted a retrospective review from November 2020 to May 2021 of Military Health System (MHS) beneficiaries who received LCS with LDCT and were referred for CAC scoring with electrocardiogram-gated CT. Of the 190 participants initially identified, 170 met study eligibility. The Agatston method was used to score CAC on both scan types.
Participants had a mean (SD) age of 62.1 (4.6) years and were 70.6% male. CAC was seen more on ECG-gated CT compared with LDCT (88% vs 74%, < .001). The Spearman correlation and Kendall W coefficient of concordance of CAC scores between the 2 scan types was 0.945 ( < .001) and 0.643, respectively. The κ statistic between CAC scores on the 2 different scans was 0.49 (SEκ = 0.048; 95% CI, -0.726-1.706), and the weighted κ statistic was 0.711. Bland-Altman analysis demonstrated a mean bias of 111.45 Agatston units, with limits of agreement between -268.64 and 491.54, suggesting CAC scores on electrocardiogram-gated CT were on average about 111 units higher than those on LDCT. There was a statistically significant proportion of nonstatin participants who met statin criteria based on additional CAC reporting ( < .001).
CAC scores are highly correlated and concordant between LDCT and electrocardiogram-gated CT. Smokers undergoing annual LDCT may benefit from concomitant CAC scoring to help stratify ASCVD risk.
吸烟是动脉粥样硬化性心血管疾病（ASCVD）的独立危险因素。有人提出将低剂量计算机断层扫描（LDCT）用于冠状动脉钙化（CAC）评分并同时进行肺癌筛查（LCS），以进一步确定ASCVD风险和死亡率。我们旨在确定LDCT在识别CAC方面的有效性及其对他汀类药物管理的影响。
我们对2020年11月至2021年5月期间接受LDCT肺癌筛查并被转诊进行心电图门控CT冠状动脉钙化评分的军事卫生系统（MHS）受益人群进行了回顾性研究。在最初确定的190名参与者中，170名符合研究资格。两种扫描类型均采用阿加斯顿方法对CAC进行评分。
参与者的平均（标准差）年龄为62.1（4.6）岁，男性占70.6%。与LDCT相比，心电图门控CT上发现的CAC更多（88%对74%，P<0.001）。两种扫描类型之间CAC评分的Spearman相关性和Kendall W一致性系数分别为0.945（P<0.001）和0.643。两种不同扫描的CAC评分之间的κ统计量为0.49（标准误κ=0.048；95%置信区间，-0.726至1.706），加权κ统计量为0.711。Bland-Altman分析显示平均偏差为111.45阿加斯顿单位，一致性界限在-268.64至491.54之间，表明心电图门控CT上的CAC评分平均比LDCT上的高约111单位。根据额外的CAC报告，有统计学意义比例的非他汀类药物使用者符合他汀类药物标准（P<0.001）。
LDCT和心电图门控CT之间的CAC评分高度相关且一致。接受年度LDCT检查的吸烟者可能会受益于同时进行的CAC评分，以帮助分层ASCVD风险。
