Qualitative coronary artery calcification scores and risk of all cause, COPD and pneumonia hospital admission in a large CT lung cancer screening cohort - 21/09/21

Doi : 10.1016/j.rmed.2021.106540

Lee Gazourian ^a,^⁎ , Shawn M. Regis ^b, Elizabeth J. Pagura ^a,^c, Lori Lyn Price ^d,^e, Melissa Gawlik ^f, Carla Lamb ^a, Kimberly M. Rieger-Christ ^g, William B. Thedinger ^c, Ava M. Sanayei ^c, William P. Long ^c, Cristina F. Stefanescu ^h, Giulia S. Rizzo ⁱ, Avignat S. Patel ^a, Carolyn E. Come ^a, Carey C. Thomson ^j,^k, Victor Pinto-Plata ^l, Katrina Steiling ^m, Andrea B. McKee ^b, Christoph Wald ⁿ, Brady J. McKee ^n,^{^{1
Co-senior authors.}}, Timothy N. Liesching ^a,^{^{1
Co-senior authors.}}
^a Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
^b Department of Medicine, Division of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
^c Tufts University School of Medicine, Boston, MA, 02111, USA
^d Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA
^e Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, 02111, USA
^f Quality and Safety, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
^g Translational Research, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
^h Department of Pediatrics, Tufts Medical Center, Boston, MA, 02111, USA
ⁱ Department of General Surgery, UMass Memorial Medical Center, Worcester, MA, 01655, USA
^j Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA
^k Harvard Medical School, Boston, MA, 02115, USA
^l Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA, 01199, USA
^m Department of Medicine, Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
ⁿ Department of Hospital Based Specialties, Division of Radiology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA

^∗Corresponding author.

Abstract

Background

Patients at high-risk for lung cancer and qualified for CT lung cancer screening (CTLS) are at risk for numerous cardio-pulmonary comorbidities. We sought to examine if qualitatively assessed coronary artery calcifications (CAC) on CTLS exams could identify patients at increased risk for non-cardiovascular events such as all cause, COPD and pneumonia related hospitalization and to verify previously reported associations between CAC and mortality and cardiovascular events.

Study design and methods

Patients (n = 4673) from Lahey Hospital and Medical Center who underwent CTLS from January 12, 2012 through September 30, 2017 were included with clinical follow-up through September 30, 2019. CTLS exams were qualitatively scored for the presence and severity of CAC at the time of exam interpretation using a four point scale: none, mild, moderate, and marked. Multivariable Cox regression models were used to evaluate the association between CT qualitative CAC and all-cause, COPD-related, and pneumonia-related hospital admissions.

Results

3631 (78%) of individuals undergoing CTLS had some degree of CAC on their baseline exam: 1308 (28.0%), 1128 (24.1%), and 1195 (25.6%) had mild, moderate and marked coronary calcification, respectively. Marked CAC was associated with all-cause hospital admission and pneumonia related admissions HR 1.48; 95% CI 1.23–1.78 and HR 2.19; 95% 1.30–3.71, respectively. Mild, moderate and marked CAC were associated with COPD-related admission HR 2.30; 95% CI 1.31–4.03, HR 2.17; 95% CI 1.20–3.91 and HR 2.27; 95% CI 1.24–4.15.

Conclusion

Qualitative CAC on CTLS exams identifies individuals at elevated risk for all cause, pneumonia and COPD-related hospital admissions.

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Keywords : Lung cancer screening, COPD, Pneumonia, Coronary artery calcification

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Qualitative coronary artery calcification scores and risk of all cause, COPD and pneumonia hospital admission in a large CT lung cancer screening cohort - 21/09/21

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