title: Coronary artery calcification on computed tomography correlates with mortality in chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  This cross-sectional study assessed the prognostic implications of computed tomography (CT) coronary artery calcification (CAC), independent of emphysema, in patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Coronary artery calcification and emphysema were assessed on noncontrast, ungated chest CT scans of patients with COPD using the validated CAC ordinal visual scale (CAC OVS; range, 0-12) and visual CT emphysema index.
  
  
  RESULTS
  A total of 200 CT images were analyzed. All-cause mortality was associated with CAC OVS greater than 4 (hazard ratio, 2.03; 95% confidence interval, 1.08-3.82; P = 0.028) and with moderate to severe CT emphysema index (hazard ratio, 4.34; 95% confidence interval, 1.53-12.33; P = 0.006). Increased emphysema severity, myocardial infarction, hypertension, and male sex independently correlated with CAC OVS greater than 4.
  
  
  CONCLUSIONS
  Coronary artery calcification severity and emphysema severity on CT images are related and are strongly as well as independently associated with prognosis in patients with moderate to severe COPD. The potential to use CAC OVS on unenhanced nongated CT as a screening tool for coronary artery disease and as a prognostic marker in patients with COPD needs further investigation in prospective studies.
authors.affiliation: From the *School of Medicine, The University of Queensland; Departments of †Medical Imaging, and ‡Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Phoebe E
authors.initials: PE
authors.lastname: OʼHare
authors.forename: Jonny F
authors.initials: JF
authors.lastname: Ayres
authors.forename: Rachael L
authors.initials: RL
authors.lastname: OʼRourke
authors.forename: Richard E
authors.initials: RE
authors.lastname: Slaughter
authors.forename: Henry M
authors.initials: HM
authors.lastname: Marshall
authors.forename: Rayleen V
authors.initials: RV
authors.lastname: Bowman
authors.forename: Kwun M
authors.initials: KM
authors.lastname: Fong
authors.forename: Ian A
authors.initials: IA
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D015984:Causality; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000706:statistics & numerical data*; D015588:Observer Variation; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality*; D011793:Queensland / Q000453:epidemiology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013223:Statistics as Topic; D015996:Survival Rate