Prognostic importance of extensive coronary calcium on lung cancer screening chest computed tomography

作者：Marcella Cabral Caires, Keren Mbondo Kasuku, Bethlehem Mengesha, Habibat Aziz Garuba, Angeline Law, Christopher B. Johnson, D. Ian Paterson, Carole J. Dennie, Elena Peña, Li Chen, Benjamin J.W. Chow, Gary R. Small · 发表于：Canadian Medical Association Journal · 年份：2024 · DOI：10.1503/cmaj.231602 · 被引用次数：10 · 研究领域：Cardiac Imaging and Diagnostics、Lung Cancer Diagnosis and Treatment、Chemotherapy-induced cardiotoxicity and mitigation

BACKGROUND: Low-dose chest computed tomography (CT) is used for lung cancer screening, but can also detect coronary artery disease as coronary artery calcium. We sought to determine the prevalence and prognostic utility of coronary artery calcium in a population at high risk of cancer. METHODS: We reviewed CT scans from consecutive participants screened for lung cancer between March 2017 and November 2018 as part of the Ontario Health Lung Cancer Screening Pilot for People at High Risk. We quantified coronary artery calcium using an estimated Agatston score. We identified the composite primary outcome of all-cause death and cardiovascular events using linked electronic medical record data from The Ottawa Hospital to December 2023. RESULTS: Among 1486 people who underwent screening CT, coronary artery calcium was detected in 1232 (82.9%) and was extensive in 439 (29.5%). On multivariable analysis, extensive coronary artery calcium was associated with the composite primary outcome (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.35-3.38), all-cause death (HR 2.39, 95% CI 1.34-4.27), and cardiovascular events (HR 2.06, 95% CI 1.13-3.77). Extensive coronary artery calcium remained predictive of cardiovascular events after we adjusted for noncardiovascular death as a competing risk (HR 2.05, 95% CI 1.09-3.85). INTERPRETATION: Among people undergoing low-dose chest CT for lung cancer screening, extensive coronary artery calcium was an independent predictor of all-cause death...