Visual Ordinal Coronary Artery Calcium Score from Non-Gated Chest CT Predicts Mortality After Severe Chronic Obstructive Pulmonary Disease Exacerbation

Abstract

Purpose

Chronic obstructive pulmonary disease (COPD) patients often undergo chest CT for various indications. Coronary artery calcium (CAC) can be quantified visually on ungated chest CT using an ordinal score that has been shown to correlate well with traditional Agatston CAC scoring. The prognostic role of CAC was studied mainly in stable COPD patients. We aim to study the association between ordinal CAC and mortality amongst patients admitted for acute exacerbation of COPD (AECOPD).

Patients and Methods

Retrospective study of AECOPD cases with no previous coronary revascularization admitted between 1st January 2016 to 30th June 2017 with a chest CT performed during admission or within 365 days prior. Ordinal CAC scoring (scale of 0–12) was performed by an experienced CT cardiologist blinded to patient data and outcomes. Patient demographics and future clinical events were retrieved from electronic medical records.

Results

There were 93 patients included (87.1% male, mean age 75 years) with the majority (59.1%) in GOLD Stage III. There were 21 (22.6%) patients with no CAC as well as 39 (41.9%) and 33 (35.5%) with ordinal CAC of 1–3 and 4–12, respectively. There were no significant differences in Charlson Comorbidity Index (CCI) and the proportion of patients with traditional cardiovascular risk factors (namely hypertension, dyslipidaemia, diabetes and smoking status) between the ordinal CAC score groups. Over a median follow-up period of 2.9 (1.1–3.9) years, there were 51 (54.8%) deaths. An ordinal CAC score of 4–12 was the only significant predictor of mortality after multivariate Cox-regression analysis adjustment for age, gender, body mass index, prior exacerbations, FEV1, cardiovascular risk factors and CCI [HR 3.944, (95% confidence interval 1.647–9.433, p = 0.002)].

Conclusion

Ordinal CAC measured from a current or recent ungated chest CT is an independent predictor of all-cause mortality in admitted AECOPD patients with no previous coronary revascularization.

Keywords:

• chronic obstructive pulmonary disease
• exacerbation
• coronary artery calcium
• mortality

Abbreviations

AECOPD, Acute Exacerbation of Chronic Obstructive Pulmonary Disease; BMI, Body Mass Index; CAC, Coronary Artery Calcium; CAD, Coronary Artery Disease; CBCCT, Certification Board of Cardiovascular Computed Tomography; CI, Confidence interval; COPDGene, Genetic Epidemiology of COPD; DSRB, Domain Specific Review Board; ECLIPSE, Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; GOLD, Global Initiatives for Chronic Obstructive Lung Disease; HR, Hazard Ratio; HSCRP, High-sensitivity C reactive protein; MESA, Multi-Ethnic Study of Atherosclerosis; PACS, Picture Archiving and Communication System; RODEO, Rosuvastatin treatment in stable COPD; SCCT, Society of Cardiovascular Computed Tomography; SD, Standard deviation.

Data Sharing Statement

The data analyzed are available upon reasonable request to the corresponding author (Dr H Xu).

Acknowledgments

The authors would like to acknowledge the support from the Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, for data collection in this study.

Disclosure

The authors do not have any relevant conflict of interests to declare.

Additional information

Funding

The authors did not receive funding for this study.