Coronary Calcium Predicts All-Cause Mortality in Suspected Acute Aortic Syndrome

Abstract

Purpose: To determine long-term clinical outcomes in patients with suspected acute aortic syndrome (AAS) and evaluate the prognostic value of coronary calcium burden as assessed with CT aortography in this symptomatic population.

Materials and methods: A retrospective cohort of all patients who underwent emergency CT aortography from January 2007 through January 2012 for suspected AAS was assembled. A medical record survey tool was used to evaluate subsequent clinical events over 10 years of follow-up. Events included death, aortic dissection, myocardial infarction, cerebrovascular accident, and pulmonary embolism. Coronary calcium scores were computed from original images using a validated simple 12-point ordinal method and categorized into none, low (1-3), moderate (4-6), or high (7-12) groupings. Survival analysis with Kaplan-Meier curves and Cox proportional hazard modeling was performed.

Results: The study cohort comprised 1658 patients (mean age, 60 years ± 16 [SD]; 944 women), with 595 (35.9%) developing a clinical event over a median follow-up of 6.9 years. Patients with high coronary calcium demonstrated the highest mortality rate (adjusted hazard ratio = 2.36; 95% CI: 1.65, 3.37). Patients with low coronary calcium demonstrated lower mortality, but rates were still almost twice as high compared with patients with no detectable calcium (adjusted hazard ratio = 1.89; 95% CI: 1.41, 2.53). Coronary calcium was a strong predictor of major adverse cardiovascular events (P < .001), which persisted after adjustment for common significant comorbidities.

Conclusion: Patients with suspected AAS had a high rate of subsequent clinical events, including death. CT aortography-based coronary calcium scores strongly and independently predicted all-cause mortality.Keywords: Acute Aortic Syndrome, Coronary Artery Calcium, CT Aortography, Major Adverse Cardiovascular Events, Mortality Supplemental material is available for this article. © RSNA, 2023See also commentary by Weir-McCall and Shambrook in this issue.

Keywords: Acute Aortic Syndrome; CT Aortography; Coronary Artery Calcium; Major Adverse Cardiovascular Events; Mortality.

Graphical abstract

Figure 1:

Flowchart shows exclusion criteria. CABG = coronary artery bypass graft, ED = emergency department, PCI = percutaneous coronary intervention.

Figure 2:

Graph shows Kaplan-Meier estimates of death in patients with no (score 0), low (score 1–3), moderate (score 4–6), and high (score 7–12) ordinal coronary artery calcium (21) (log-rank test P < .001).

Figure 3:

Graph shows Kaplan-Meier estimates of major adverse cardiovascular events (MACE) in patients with no (score 0), low (score 1–3), moderate (score 4–6), and high (score 7–12) ordinal coronary artery calcium (21) (log-rank test P < .001).

Figure 4:

Graphs show Kaplan-Meier estimates of (A) myocardial infarction (MI), (B) cerebrovascular accident (CVA), (C) acute aortic syndrome (AAS), and (D) pulmonary embolism (PE) in patients with no (score 0), low (score 1–3), moderate (score 4–6), and high (score 7–12) ordinal coronary artery calcium (21) (log-rank test P < .001 for MI, P < .001 for CVA, P = .51 for AAS, and P = .79 for PE).