Coronary Artery Calcium Can Predict All-Cause Mortality and Cardiovascular Events on Low-Dose CT Screening for Lung Cancer
ABSTRACT Performing coronary artery calcium (CAC) screening as part of low-dose CT lung cancer screening has been proposed as an efficient strategy to detect people with high cardiovascular risk and improve outcomes of primary prevention. This study aims to investigate whether CAC measured on low-dose CT in a population of former and current heavy smokers is an independent predictor of all-cause mortality and cardiac events.
We used a case-cohort study and included 958 subjects 50 years old or older within the screen group of a randomized controlled lung cancer screening trial. We used Cox proportional-hazard models to compute hazard ratios (HRs) adjusted for traditional cardiovascular risk factors to predict all-cause mortality and cardiovascular events.
During a median follow-up of 21.5 months, 56 deaths and 127 cardiovascular events occurred. Compared with a CAC score of 0, multivariate-adjusted HRs for all-cause mortality for CAC scores of 1-100, 101-1000, and more than 1000 were 3.00 (95% CI, 0.61-14.93), 6.13 (95% CI, 1.35-27.77), and 10.93 (95% CI, 2.36-50.60), respectively. Multivariate-adjusted HRs for coronary events were 1.38 (95% CI, 0.39-4.90), 3.04 (95% CI, 0.95-9.73), and 7.77 (95% CI, 2.44-24.75), respectively.
This study shows that CAC scoring as part of low-dose CT lung cancer screening can be used as an independent predictor of all-cause mortality and cardiovascular events.
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ABSTRACT: Lung cancer is the most common cause of cancer-related death in the world. The Dutch-Belgian Randomized Lung Cancer Screening Trial (Dutch acronym: NELSON) was launched to investigate whether screening for lung cancer by low-dose multidetector computed tomography (CT) in high-risk patients will lead to a decrease in lung cancer mortality. The NELSON lung nodule management is based on nodule volumetry and volume doubling time assessment. Evaluation of CT examinations in lung cancer screening can also include assessment of coronary calcification, emphysema and airway wall thickness, biomarkers for major diseases that share risk factors with lung cancer. In this review, a practical approach to the radiological evaluation of CT lung cancer screening examinations is described.Cancer Imaging 01/2013; 13(3):391-9. DOI:10.1102/1470-7330.2013.9043 · 1.29 Impact Factor
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ABSTRACT: BACKGROUND: -Coronary calcium score (CS), traditionally based on electrocardiography (ECG)-triggered computed tomography (CT), predicts cardiovascular risk. Nowadays, non-triggered thoracic CT is extensively utilized, such as in lung cancer screening. The study-purpose was to determine the correlation in CS between non-triggered and ECG-triggered CT, and to evaluate the prognostic performance of the CS derived from non-triggered CT. METHODS AND RESULTS: -PubMed, Embase and Web of Knowledge were searched until November, 2012. Two reviewers independently screened 2,120 records to identify studies reporting the CS in non-triggered CT, and extracted information. Study quality was evaluated by standardized assessment tools. Cohen's κ was extracted for agreement of CS categories between non-triggered and ECG-triggered CT (validation). Hazard ratio was extracted for prognostic performance. Five studies comprising 1,316 individuals were included regarding validation. Five studies comprising 34,028 cardiac asymptomatic individuals, mainly from lung cancer screening trials, were included regarding prognosis. All studies were of high quality. Meta-analysis could only be performed for validation studies, as studies on prognostic performance were highly heterogeneous. Pooled Cohen's κ for agreement between the two techniques was 0.89 (95%CI: 0.83 to 0.95) for increasing CS categories. Increasing CS categories were associated with increasing risk of cardiovascular death or events. Non-triggered CT yielded false-negative CS in 8.8% of individuals, and underestimated high CS in 19.1%. CONCLUSIONS: -Our analysis shows the prognostic value and potential role of non-triggered assessment of coronary calcium, but it does not suggest that ECG-triggered CT should be replaced by non-triggered exams.Circulation Cardiovascular Imaging 06/2013; 6(4). DOI:10.1161/CIRCIMAGING.113.000092 · 6.75 Impact Factor
- Circulation Cardiovascular Imaging 07/2013; 6(4):494-5. DOI:10.1161/CIRCIMAGING.113.000730 · 6.75 Impact Factor