title: Relationship and prognostic value of modified coronary artery calcium score, FEV1, and emphysema in lung cancer screening population: the MILD trial.
abstract: OBJECTIVE
  To assess the relationship between a modified coronary artery calcium (mCAC) score and both forced expiratory volume in 1 second (FEV1) and pulmonary emphysema and the associations of such factors with all-cause mortality and cardiovascular events (CVEs) in a lung cancer computed tomographic (CT) screening trial.
  
  
  METHODS
  In this institutional review board-approved study, both clinical and low-dose CT data were evaluated in a cohort of heavy smokers consecutively recruited by the Multicentric Italian Lung Detection, or MILD, trial. Low-dose CT images were analyzed by using software that allowed quantification of mCAC, mean lung attenuation (MLA), and total extent of emphysema. The correlations between mCAC, percentage predicted FEV1, MLA, and emphysema extent were tested by using the Pearson correlation coefficient. Adjusted multiple logistic regression models were applied to assess the relationships between mCAC, FEV1, MLA, and emphysema extent and all-cause mortality and CVEs.
  
  
  RESULTS
  The final study cohort consisted of 1159 smokers. There were no significant correlations between mCAC score and FEV1 (r=-0.03, P=.4), MLA (r=-0.01, P=.7), or emphysema extent (r=0.02, P=.6). An mCAC score greater than 400 was the only factor that was independently associated with both all-cause mortality (odds ratio [OR]: 3.73; 95% confidence interval [CI]: 1.05, 13.32; P=.04) and CVEs (OR: 2.87; 95% CI: 1.13, 7.27; P=.03).
  
  
  CONCLUSIONS
  mCAC is a better predictor of CVE and all-cause mortality than FEV1 and emphysema extent and may contribute to the identification of high-risk individuals in a lung cancer screening setting.
authors: Department of Clinical Sciences, Section of Diagnostic Imaging, University of Parma, Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100 Parma, Italy. nicola.sverzellati@unipr.it
authors: Nicola
authors: N
authors: Sverzellati
authors: Filippo
authors: F
authors: Cademartiri
authors: Francesca
authors: F
authors: Bravi
authors: Chiara
authors: C
authors: Martini
authors: Federica A
authors: FA
authors: Gira
authors: Erica
authors: E
authors: Maffei
authors: Alfonso
authors: A
authors: Marchianò
authors: Carlo
authors: C
authors: La Vecchia
authors: Massimo
authors: M
authors: De Filippo
authors: Jan-Martin
authors: JM
authors: Kuhnigk
authors: Cristina
authors: C
authors: Rossi
authors: Ugo
authors: U
authors: Pastorino
mesh_terms: D000368:Aged; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality*; D004646:Emphysema / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D013223:Statistics as Topic; D016019:Survival Analysis; D015996:Survival Rate; D061205:Vascular Calcification / Q000175:diagnosis / Q000401:mortality*