Coronary artery calcification scoring system based on the coronary artery calcium data and reporting system (CAC-DRS) pr
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ORIGINAL ARTICLE
Coronary artery calcification scoring system based on the coronary artery calcium data and reporting system (CAC‑DRS) predicts major adverse cardiovascular events or all‑cause death in patients with potentially curable lung cancer without a history of cardiovascular disease Kazuhiro Osawa1 · Akihiro Bessho2 · Soichiro Fuke1 · Shigeharu Moriyama3 · Asako Mizobuchi1 · Shunsuke Daido1 · Masamichi Tanaka1 · Akihisa Yumoto1 · Hironori Saito1 · Hiroshi Ito4 Received: 9 January 2020 / Accepted: 15 May 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract The coronary artery calcium data and reporting system (CAC-DRS) is a novel reporting system based on CAC severity. Lung cancer patients have a high risk of cardiovascular disease (CVD), for which CAC severity may provide additional prognostic information. Using non-gated, non-contrast computed tomography (CT), we evaluated the CAC-DRS for predicting CVD and all-cause death in patients with potentially curable resected lung cancer. We retrospectively studied 309 consecutive patients without a history of CVD (mean age 67.4 ± 8.2 years, 61% male) who underwent curative surgery for non-small-cell lung cancer between May 2012 and March 2019 at the Japanese Red Cross Okayama Hospital. Time to incidence of major adverse cardiac events (MACEs) (non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and all-cause death was analyzed using Fine and Gray and Cox regression models. The CAC-DRS score was assessed using standard chest CT without electrocardiogram gating. During 52-months’ median follow-up, 43 patients (13.4%) developed incident MACEs or died from any cause; the pathological cancer stages were Ia (n = 20), Ib (n = 8), IIa (n = 2), IIb (n = 2) and IIIa (n = 11). Patients had a graded increase in incidence of MACEs or all-cause death with increasing categories of CAC-DRS. The CAC-DRS score was significantly associated with incident MACEs or all-cause death after adjusting for confounding factors (hazard ratio 1.18; 95% confidence interval 1.10–1.25, p 140 mmHg, diastolic blood pressure > 90 mmHg, or use of prescribed anti-hypertensive medication [18]. To estimate risk of cardiovascular events, the 10-year atherosclerotic CVD (ASCVD) event risk score was calculated using the published Pooled Cohort Equationbased algorithm [19].
CT protocol All chest CT examinations were performed within 1 month before surgery using a 64-slice CT scanner (Toshiba Acquilion, Tokyo, Japan) at the Japanese Red Cross Okayama Hospital. All scans were non-electrocardiogram (ECG) gated and non-contrast, and the patients’ heart rates were uncontrolled. All participants were scanned in the supine position at end-inspiration. The CT parameters were as follows: detector collimation 64 × 0.5 mm using a helical acquisition protocol, table pitch 0.84, and rotation time 350–400 ms. The tube current was regulated with automatic exposure control, and the tube voltage was 120 kVp. The scanning field of view was 320 mm, the matrix size was 512 × 512, and th
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