Prognostic Value of Incidental Coronary Artery Calcifications in Computed Tomography Pulmonary Angiography for Suspected Pulmonary Embolism

Computed tomography (CT) has emerged as a noninvasive method to identify coronary artery calcifications (CAC). We sought to investigate the association between opportunistic visual CAC evaluation in patients without known coronary artery disease who underwent CT pulmonary angiography (CTPA) for pulmonary embolism (PE) suspicion, and cardiovascular prognosis. We analyzed data of patients who underwent CTPA for suspected PE in 2017 at CHU Dupuytren, Limoges, France. Patients were categorized into 4 groups according to a simple visual ordinal score to assess the extent and severity of CAC on a whole-patient basis: none (grade 0), mild (grade 1), moderate (grade 2), and severe (grade 3). The primary outcome was a composite of cardiovascular mortality, myocardial infarction (MI), or coronary revascularization. The secondary outcomes were all-cause mortality, and an extended composite outcome including cardiovascular mortality, MI, coronary revascularization, ischemic stroke, ischemic peripheral events, and hospitalization for heart failure. A total of 414 patients (mean age 69.7 ± 14.3 years, 42% men, 18.1% PE) were included in the analysis and subdivided according to CAC categories as follows: grade 0 (n = 123; 29.7%), grade 1 (n = 133; 32.1%), grade 2 (n = 79; 19.1%) and grade 3 (n = 79; 19.1%). The mean follow-up was 3.5 ± 2.4 years. After adjustment, the presence of CAC grade 2 to 3 CAC independently predicted the primary outcome (hazard ratio [HR] = 5.30, 95% CI 2.56 to 10.98, p <0.001). CAC grade 2 to 3 were also independent predictors for all-cause mortality (HR = 1.52, 95% CI 1.10 to 2.11, p = 0.011); and the extended composite event (HR = 1.82, 95% CI 1.13 to 2.95, p = 0.014). In conclusion, the opportunistic assessment of CAC in CTPA for suspected PE could provide important mid-term prognostic information, independently from the PE findings.