Schwartz Andrew W, Maahs Ethan, Berezowitz Alexa, Mojibian Hamid, Guzman Raul J
Yale School of Medicine, New Haven, CT.
Yale University, New Haven, CT.
J Vasc Surg. 2025 Aug;82(2):591-598.e2. doi: 10.1016/j.jvs.2025.03.196. Epub 2025 Mar 28.
The extent of calcification in the tibial and coronary arteries predicts major ischemic events. Tibial calcification predicts ischemic events in a manner independent of the degree of associated atherosclerotic occlusive disease, and coronary calcification can improve risk stratification in patients at intermediate risk for cardiovascular disease. We thus assessed the relationship between tibial and coronary calcification, the influence of cardiovascular risk factors on their extent, and their individual predictive value on major adverse limb events (MALEs) and major adverse cardiac events (MACEs).
We retrospectively reviewed images and collected the demographic and cardiovascular risk factor data of patients who underwent computed tomography scans of the lower extremities and chest. Calcification in the tibial and coronary arteries were identified and scored using semi-automated methods. A Spearman correlation coefficient was calculated using tibial artery calcification (TAC) and coronary artery calcification (CAC) scores. Ordinal logistic regression and multiple linear regression were performed using cardiovascular and demographic factors as covariates. Log-rank test and Kaplan-Meier estimate were completed to assess MACE- and MALE-free probabilities.
A total of 101 patients were identified who met inclusion criteria. There was a strong correlation (r = 0.76) between CAC and TAC scores. Severe CAC (defined as >400) and severe TAC (defined as >500) scores were both associated with advanced age, male sex, a history of smoking, and diabetes. Renal disease was associated with a high TAC score, but not CAC. An increasing TAC score was associated with increased MACE (P < .0001) and MALEs (P = .039). However, increasing CAC was only associated with increased MACEs (P = .0036).
We provide data suggesting that TAC and CAC share similar risk factors and are highly correlated. Interestingly, TAC predicts both MACEs and MALEs, whereas CAC is best at predicting coronary, but not lower extremity events. Further studies are needed to understand the contributions of arterial calcification to myocardial and lower extremity ischemia.
胫骨和冠状动脉钙化程度可预测主要缺血事件。胫骨钙化以独立于相关动脉粥样硬化闭塞性疾病程度的方式预测缺血事件，而冠状动脉钙化可改善心血管疾病中度风险患者的风险分层。因此，我们评估了胫骨和冠状动脉钙化之间的关系、心血管危险因素对其程度的影响以及它们对主要肢体不良事件（MALE）和主要心脏不良事件（MACE）的个体预测价值。
我们回顾性分析了接受下肢和胸部计算机断层扫描患者的影像资料，并收集了他们的人口统计学和心血管危险因素数据。采用半自动方法识别并对胫骨和冠状动脉钙化进行评分。使用胫骨动脉钙化（TAC）和冠状动脉钙化（CAC）评分计算Spearman相关系数。以心血管和人口统计学因素作为协变量进行有序逻辑回归和多元线性回归分析。完成对数秩检验和Kaplan-Meier估计以评估无MACE和无MALE概率。
共确定101例符合纳入标准的患者。CAC和TAC评分之间存在强相关性（r = 0.76）。严重CAC（定义为>400）和严重TAC（定义为>500）评分均与高龄、男性、吸烟史和糖尿病相关。肾病与高TAC评分相关，但与CAC无关。TAC评分增加与MACE（P < .0001）和MALE（P = .039）增加相关。然而，CAC增加仅与MACE增加相关（P = .0036）。
我们提供的数据表明，TAC和CAC具有相似的危险因素且高度相关。有趣的是，TAC可预测MACE和MALE，而CAC最擅长预测冠状动脉事件，而非下肢事件。需要进一步研究以了解动脉钙化对心肌和下肢缺血的影响。
