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. 2025 Sep 30;11(1):84.
doi: 10.1186/s40959-025-00389-4.

The predictive value of coronary artery calcium deposit for cardiovascular events in patients treated with immune checkpoint inhibitors

Moaad Slieman  1   2 , Ophir Freund  2   3 , Galit Aviram  2   4 , Haim Shmilovich  1   2 , Zach Rozenbaum  1   2   5 , Moran Gvili Perelman  1   2 , Lior Zornitzki  1   2 , Dana Viskin  1   2 , Anna Rozenfeld Hemed  1   2 , Shafik Khoury  1   2 , Ofer Havakuk  1   2 , Yan Topilsky  1   2 , Shmuel Banai  1   2 , Joseph Carver  6 , Michal Laufer-Perl  7   8
Affiliations

The predictive value of coronary artery calcium deposit for cardiovascular events in patients treated with immune checkpoint inhibitors

Moaad Slieman et al. Cardiooncology. .

Abstract

Background: Immune checkpoint inhibitors (ICIs) have become the standard for treating various cancers. Nevertheless, their use may lead to significant cardiovascular immune-related adverse events (CV irAEs).

Objectives: We aimed to assess whether pre-treatment coronary artery calcium (CAC) deposition predicts CV irAEs in patients treated with ICIs.

Methods: A retrospective single-center cohort of patients treated with ICIs who performed pre-treatment chest computed tomography. A visual CAC assessment was categorized into Positive or Negative calcium deposits. Patients with pre-existing ischemic heart disease were excluded. The primary endpoint was the composite CV irAEs, including myocarditis, acute coronary syndrome, heart failure, and arrhythmias, and the secondary endpoint was all-cause mortality.

Results: The cohort included 240 patients with a median age of 67 (IQR 59-73) years and 47% female. The most prevalent type of cancer was lung cancer (36%), and the prominent ICIs was pembrolizumab (54%). Patients with Positive CAC (38%) were predominantly male, with higher rates of cardiovascular comorbidities. The primary outcome occurred in 36 cases (15%) at a median of 94 (IQR 48-338) days from the first ICIs dose. The Positive CAC group observed a non-significant trend toward a higher hazard for CV irAEs (HR 1.66, 95% CI 0.86-3.21, p = 0.13), with no significant difference in all-cause mortality (HR 1.15, 95% CI 0.88-1.51, p = 0.30).

Conclusion: Pre-treatment CAC deposition did not demonstrate an independent predictive role in assessing the risk of CV irAEs and all-cause mortality in patients treated with ICIs.

Keywords: Cardio-oncology, chest CT; Cardiotoxicity; ICI; Immune checkpoint inhibitor; Immunotherapy.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Disclosures: All authors have nothing to disclose. The study was approved by the Tel Aviv Sourasky Medical Center Helsinki committee (#TLV-0228-16).

Figures

Fig. 1
Fig. 1
Distribution of malignancies in the study cohort. GI = gastrointestinal; TCC = transitional cell carcinoma
Fig. 2
Fig. 2
Kaplan-Meier analysis of cardiovascular events stratified by patients with (green) and without (blue) coronary calcifications
Fig. 3
Fig. 3
Kaplan-Meier analysis of cardiovascular events stratified by patients with (green) and without (blue) aortic calcifications
Fig. 4
Fig. 4
Kaplan-Meier analysis of mortality stratified by patients with (green) and without (blue) coronary calcifications
See this image and copyright information in PMC

References

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