Different prognostic significance of coronary artery and aortic valve calcium in patients with chest pain

• Published in: European radiology Vol. 34; no. 4; pp. 2658 - 2664
• Main Authors: Marcos-Mangas, Marta, Revilla-Orodea, Ana, Sevilla, Teresa, González-Bartol, Esther, Sánchez-Lite, Israel, Urueña-Martínez, Noelia, Arnold, Roman, Gómez, Itziar, San Román, J. Alberto
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2024; Springer Nature B.V
• Subjects: Acute coronary syndromes; Aorta; Aortic valve; Calcification; Calcification (ectopic); Cardiac; Cardiovascular disease; Cardiovascular diseases; Chest; Computed tomography; Congestive heart failure; Coronary artery disease; Coronary vessels; Diagnostic Radiology; EKG; Health risks; Heart diseases; Heart valves; Imaging; Internal Medicine; Interventional Radiology; Medicine; Medicine & Public Health; Neuroradiology; Pain; Radiology; Regression analysis; Rheumatic heart disease; Stroke; Ultrasound; Vein & artery diseases; Cardiovascular disease; Aortic valve calcium; Coronary artery calcium; Computerized tomography; Risk factors
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-10229-7

Objectives Coronary artery calcification (CorCa) identifies high cardiovascular risk in the general population. In this setting, aortic valve calcification (AoCa) showed contradictory results. Our goal has been to assess the prognostic power of CorCa and AoCa in patients with chest pain who underwent an ECG-gated cardiac multidetector CT (cardiac-MDCT). Methods A total of 528 patients without previous known coronary artery disease, with chest pain who underwent a cardiac-MDCT multidetector, were retrospectively recruited. The primary endpoint included death, acute coronary syndrome, stroke, and heart failure. Results A total of 61 patients (11.6%) had an event during a mean follow-up of almost 6 years (5.95 ± 2.98). The most frequent event was acute coronary syndrome (6.4%). Total mortality was 4.5%. Patients with CorCa > 0 had more events than those without CorCa (17.3% versus 4.3%; p  < 0.001). Likewise, when only patients without AoCa were considered ( n  = 118), clinical events were more frequent in those with CorCa (12.7% versus 3.6%; p  = 0.004). After excluding patients with coronary artery disease, events were more frequent in those with CorCa (12.6% versus 4.3%; p  = 0.004). The higher the Agatston score, the more frequent the events. Patients with AoCa  > 0 had more events than those without (16.5% versus 7.3%; p  < 0.001), but in patients without CorCa, no difference in events was seen (6.2% versus 3.6%; p  = 0.471). A Cox regression analysis showed age, smoking, prior stroke, and CorCa but not AoCa to be independently related to events. Conclusions In summary, CorCa, but not AoCa, is related to cardiovascular events in patients with chest pain who undergo a cardiac-MDCT. Clinical relevance statement We show that coronary artery calcification, but not aortic valve calcification, detected in a coronary CT scan is tightly related to cardiovascular events. Although this is a message already shown by other groups in the general population, we do believe that this work is unique because it is restricted to patients with chest pain sent to coronary CT. In other words, our work deals with what we face in our routine everyday practice. Key Points • The presence and the amount of coronary artery calcification are associated with cardiovascular events in patients with chest pain. • Aortic valve calcification is not associated with cardiovascular events in patients with chest pain.