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. 2024 Dec 1;196(41):E1362-E1369.
doi: 10.1503/cmaj.231602.

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

Marcella Cabral Caires  1 , Keren Mbondo Kasuku  1 , Bethlehem Mengesha  1 , Habibat Garuba  1 , Angeline Law  1 , Christopher Johnson  1 , David Ian Paterson  1 , Carole Dennie  1 , Elena Pena  1 , Li Chen  1 , Benjamin J W Chow  1 , Gary R Small  2
Affiliations

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

Marcella Cabral Caires et al. CMAJ. .

Abstract

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 and cardiovascular events, even after adjustment for noncardiovascular death. The opportunity to identify and reduce risks from coronary artery disease may represent an additional benefit of lung cancer screening.

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Conflict of interest statement

Competing interests:: David Ian Paterson reports receiving an honorarium for an education event from AstraZeneca Canada. Carole Dennie reports receiving consulting fees from AstraZeneca, outside the submitted work, and held unpaid roles with the North American Society for Cardiovascular Imaging and the Canadian Society of Thoracic Radiology. Benjamin Chow reports receiving research support from TD Bank and Artrya. Gary Small reports receiving a research grant for amyloid research from Pfizer and honoraria from Pfizer and Alnylam (all paid to institution, outside the submitted work). No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Coronary artery calcification on low-dose chest computed tomography (CT). Transaxial image of a lung cancer screening CT scan, showing coronary artery calcium in all 3 coronary arteries. Note: LAD = left anterior descending artery, LCX = left circumflex artery, RCA = right coronary artery.
Figure 2:
Figure 2:
Kaplan–Meier survival curves for all-cause death according to extent of coronary artery calcium.
See this image and copyright information in PMC

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