Coronary artery calcification detected in lung cancer screening predicts cardiovascular death.
OBJECTIVE
It remains unknown whether non-electrocardiogram-gated coronary artery calcium (CAC) score in lung cancer screening provides incremental prognostic value. The aim of this study was to evaluate the prognostic value of CAC in the Danish Lung Cancer Screening Trial (DLCST), in addition to conducting a systematic review and meta-analysis including previously published studies regarding CAC in lung cancer screening.


METHODS
In DLCST, we measured Agatston CAC scores in 1,945 current and former smokers. Causes of death were extracted from the Danish National Death Registry. We used Cox proportional hazards model to determine hazard ratios (HRs) of CAC scores. A weighted fixed-effects model was used for the meta-analysis.


RESULTS
Median follow-up in DLCST was 7.1 years, and 55% were men. Overall survival rates associated with CAC scores of 0, 1-400, and > 400 were 98%, 96%, and 92% (p < 0.001), respectively. Adjusted HR of cardiovascular death associated with CAC >400 was 3.8 (1.0-15) (p < 0.05). The meta-analysis included 28,045 asymptomatic participants. A high non-gated CAC score was associated with fatal or non-fatal cardiovascular events (p < 0.0001).


CONCLUSIONS
Assessment of non-electrocardiogram-gated CAC in lung cancer screening programs is a robust prognostic measure of fatal or non-fatal cardiovascular events in current and former smokers independent of traditional cardiovascular risk factors.
Department of Cardiology, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
Thomas
T
Rasmussen
Lars
L
Køber
Jawdat
J
Abdulla
Jesper Holst
JH
Pedersen
Mathilde Marie Winkler
MM
Wille
Asger
A
Dirksen
Klaus Fuglsang
KF
Kofoed
D002114:Calcinosis / Q000175:diagnosis*; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D003331:Coronary Vessels / Q000473:pathology*; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
atherosclerosis; coronary artery calcium score; lung cancer screening; smoking