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

Lee Gazourian; Shawn M Regis; Elizabeth J Pagura; Lori Lyn Price; Melissa Gawlik; Carla Lamb; Kimberly M Rieger-Christ; William B Thedinger; Ava M Sanayei; William P Long; Cristina F Stefanescu; Giulia S Rizzo; Avignat S Patel; Carolyn E Come; Carey C Thomson; Victor Pinto-Plata; Katrina Steiling; Andrea B McKee; Christoph Wald; Brady J McKee; Timothy N Liesching

doi:10.1016/j.rmed.2021.106540

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

Respir Med. 2021 Sep:186:106540. doi: 10.1016/j.rmed.2021.106540. Epub 2021 Jul 12.

Authors

Lee Gazourian¹, Shawn M Regis², Elizabeth J Pagura³, Lori Lyn Price⁴, Melissa Gawlik⁵, Carla Lamb⁶, Kimberly M Rieger-Christ⁷, William B Thedinger⁸, Ava M Sanayei⁸, William P Long⁸, Cristina F Stefanescu⁹, Giulia S Rizzo¹⁰, Avignat S Patel⁶, Carolyn E Come⁶, Carey C Thomson¹¹, Victor Pinto-Plata¹², Katrina Steiling¹³, Andrea B McKee², Christoph Wald¹⁴, Brady J McKee¹⁴, Timothy N Liesching⁶

Affiliations

¹ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA. Electronic address: Lee.Gazourian@lahey.org.
² Department of Medicine, Division of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
³ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA; Tufts University School of Medicine, Boston, MA, 02111, USA.
⁴ Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, 02111, USA.
⁵ Quality and Safety, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
⁶ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
⁷ Translational Research, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
⁸ Tufts University School of Medicine, Boston, MA, 02111, USA.
⁹ Department of Pediatrics, Tufts Medical Center, Boston, MA, 02111, USA.
¹⁰ Department of General Surgery, UMass Memorial Medical Center, Worcester, MA, 01655, USA.
¹¹ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA; Harvard Medical School, Boston, MA, 02115, USA.
¹² Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA, 01199, USA.
¹³ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston, MA, 02118, USA.
¹⁴ Department of Hospital Based Specialties, Division of Radiology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.

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.

Keywords: COPD; Coronary artery calcification; Lung cancer screening; Pneumonia.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Coronary Artery Disease / diagnosis*
Early Detection of Cancer / methods*
Female
Hospitalization*
Humans
Lung Neoplasms / diagnostic imaging*
Male
Middle Aged
Pneumonia*
Pulmonary Disease, Chronic Obstructive*
Retrospective Studies
Risk
Risk Assessment
Tomography, X-Ray Computed*
Vascular Calcification / diagnosis*

Grants and funding

UL1 TR002544/TR/NCATS NIH HHS/United States