Prognostic value of coronary calcification detected via non-electrocardiogram-gated computed tomography in patients with cardiovascular disease: A retrospective cohort study

Background: The correlation between coronary artery calcification (CAC) detected via electrocardiogram-gated computed tomography (ECG-gated CT) and future cardiovascular events has been well-established. Non-ECG-gated CT is simple and widely used, making it suitable for screening. However, the correlation between CAC observed via non-ECG-gated CT and cardiovascular and non-cardiovascular events remains unclear. Therefore, we examined the association between coronary calcification detected via non-ECG-gated CT and prognosis.

Methods: This non-randomized, retrospective cohort study included 353 consecutive patients with cardiovascular diseases (male/female 229/124; mean age, 68.6 ± 12.7 years) who underwent non-ECG-gated CT between October 1, 2017 and May 31, 2021. Correlations between the Agatston score and cardiovascular and non-cardiovascular events were evaluated. The Agatston scores were divided into three tertiles (low, intermediate, and high) and compared. The primary endpoint was composite cardiovascular events, including cardiac death, myocardial infarction, hospitalization for congestive heart failure, stroke, and unplanned cardiac surgery. The secondary endpoint was composite non-cardiovascular events, including non-cardiovascular death, cancer development, and hospitalization for a non-cardiovascular worsening event.

Results: During the median follow-up period of 16.9 (interquartile range, 2.2-38.6) months, 83 patients reached the primary endpoint, while 81 patients reached the secondary endpoint. Kaplan-Meier analysis indicated that patients with high Agatston scores had a significantly higher incidence of cardiovascular and non-cardiovascular events than those with low Agatston scores (p < 0.001).

Conclusions: In this study, the Agatston score obtained using non-ECG-gated CT predicted cardiovascular and non-cardiovascular events. Non-ECG-gated CT can be easily performed, aiding early detection in patients with high event rates.