TY - JOUR

T1 - Coronary artery calcification detected in lung cancer screening predicts cardiovascular death

AU - Rasmussen, Thomas

AU - Køber, Lars

AU - Abdulla, Jawdat

AU - Pedersen, Jesper Johannes Holst

AU - Wille, Mathilde Marie Winkler

AU - Dirksen, Asger

AU - Kofoed, Klaus Fuglsang

PY - 2015/6

Y1 - 2015/6

N2 - OBJECTIVES: 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.DESIGN: 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).CONCLUSION: 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.

AB - OBJECTIVES: 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.DESIGN: 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).CONCLUSION: 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.

KW - Calcinosis

KW - Cause of Death

KW - Coronary Artery Disease

KW - Coronary Vessels

KW - Denmark

KW - Early Detection of Cancer

KW - Female

KW - Humans

KW - Lung Neoplasms

KW - Male

KW - Middle Aged

KW - Outcome Assessment (Health Care)

KW - Prognosis

KW - Proportional Hazards Models

KW - Registries

KW - Smoking

KW - Survival Rate

KW - Tomography, X-Ray Computed

U2 - 10.3109/14017431.2015.1039572

DO - 10.3109/14017431.2015.1039572

M3 - Journal article

C2 - 25919145

VL - 49

SP - 159

EP - 167

JO - Scandinavian Cardiovascular Journal

JF - Scandinavian Cardiovascular Journal

SN - 1401-7458

IS - 3

ER -