Coronary Artery Calcification Score Based On Non-Gated Chest CT Predicts Early Cardiovascular Risk After Lung Cancer Surgery

Objectives1.To evaluate whether coronary artery calcium scores(CACS)measured by non-gated chest computer tomography(NCCT)could predict perioperative cardiovascular events in patients underwent intermediate-risk lung cancer surgery.2.To compare the impact of slice thickness on the consistency and predictive value of CACS from NCCT.MethodsIt was a single-center retrospective study.1.3148 lung cancer patients were selected from Shanghai Chest Hospital from January to June 2017,and NCCT was performed 3 months before operation.CACS were calculated with NCCT images by using software Osiri X,and the number of calcified vessels,the distribution and severity of calcified lesions,and the influencing factors of coronary calcification were also analyzed.2.According to the criteria of ESC guidelines on non-cardiac surgery cardiovascular assessment and management,3112 patients with intermediate-risk lung surgery were further selected.CACS based on NCCT images were measured and the perioperative cardiovascular risk factors were identified by multivariate Logistic regression analysis.Perioperative cardiovascular events were defined as cardiac death, nonfatal acute coronary syndrome,pulmonary edema,atrial and ventricular arrhythmia with hemodynamic compromise,and complete heart block during hospitalization.3.A total of 2230 patients with NCCT scanning in conventional reconstruction thickness of 5mm and thin reconstruction thickness of 1mm were selected.We compared the consistency of CACS with different thickness in assessing the severity of calcification,and the influence of thickness on the predictive value of CACS.Results1.The positive rate of coronary artery calcification in 3148 patients underwent lung surgery was 24.5%.The prevalence and severity of coronary calcification increased with age and was substantially more common in men(36.9% vs 16.7%,P<0.001).The main influencing factors of coronary calcification include age(OR=1.11,95%CI: 1.10-1.12,P<0.001),smoking(OR=2.06,95%CI: 1.60-2.64,P<0.001),BMI(OR=1.04,95%CI: 1.01-1.07,P=0.027),diabetes(OR=1.61,95%CI: 1.18-2.19,P=0.003),stroke(OR=1.84,95%CI: 1.01-3.37,P=0.048),ischemic heart disease(OR=2.46,95%CI: 1.14-5.30,P=0.021)and chronic kidney disease(OR=2.93,95%CI: 1.32-6.52,P=0.008).2.The incidence of perioperative cardiovascular events was 2.7% in lung cancer patients underwent moderate risk surgery.In the multivariate analysis,CACS ≥1(OR=1.75,95%CI: 1.08-2.84,P=0.023)or number of calcified vessels(OR=1.25,95%CI: 1.02-1.54,P=0.038),age(OR=1.06,95%CI: 1.03-1.10,P<0.001),pulmonary function classification(OR=1.89,95%CI:1.42-2.53,P<0.001)and thoracotomy(OR=3.06,95%CI: 1.78-5.26,P<0.001)were predictive factors of cardiovascular complications.3.CACS from 1mm and 5mm NCCT demonstrated a strong Pearson correlation,R=0.862(P<0.001),while the consistency of CACS categories between the two groups was insufficient,Kappa=0.550(P<0.001).The number of calcified vessels evaluated by different thickness had a strong correlation,R=0.812(P<0.001);while the consistency was insufficient,kappa = 0.586(P<0.001).Multivariate regression analysis showed that only CACS ≥ 1 or the number of calcified vessels based on the 1.0mm thickness NCCT had predictive value for perioperative cardiovascular risk.ConclusionsCACS based on NCCT can be used to assess the risk of perioperative cardiovascular events in patients with moderate-risk lung cancer surgery.The cardiovascular risk of patients with coronary artery calcification is 1.75 times higher than patients without calcification.The prediction value of perioperative cardiovascular risk was better in CACS calculated by 1.0mm reconstruction thickness,while the conventional 5 mm images tend to underestimate calcification.