Coronary Artery Calcium Detected on Lung Cancer Screening CT and All-Cause Mortality: The National Lung Screening Trial
People who are at risk for lung cancer due to a history of heavy smoking are also at increased risk for coronary artery disease (CAD). The utility of low-dose CT for the purpose of lung cancer screening is currently under study. Coronary artery calcium (CAC), a surrogate marker for atherosclerotic plaque burden, can also be quantified from low-dose ungated CT. The presence and extent of CAC has been shown to strongly predict all-cause and CAD mortality. The ability to detect increased risk for CAD during low-dose CT lung cancer screening may provide important additional value to screening CT in these patients. Therefore, we aim to quantify coronary artery calcium in the low-dose gated screening CT scans which have been collected as part of the National Lung Screening Trial in order to: Specific Aim 1: Examine whether the assessment of coronary artery calcium (CAC) measured by low-dose CT improves prediction of all-cause mortality. Hypothesis 1a: All-cause mortality will be increased in study subjects who have CAC at baseline, even after adjusting for current smoking and pack-years of smoking. Hypothesis 2a: All-cause mortality will increase with the severity of CAC score, and CAC extent will provide additional incremental information regarding mortality risk beyond other established risk factors (history of diabetes, heart disease, increasing age, male sex, current smoking and pack-years of smoking). Specific Aim 2: Determine whether serial measurements of CAC add to the prediction of all-cause mortality Hypothesis 2a: Progression of CAC over two years of follow-up will predict increased risk of all-cause mortality Hypothesis 2b: The measurement of serial CAC scores will add incremental information regarding all-cause mortality risk independent of the extent of CAC present at the baseline examination
Visual scoring of coronary artery calcification in lung cancer screening computed tomography: association with all-cause and cardiovascular mortality risk.
Watts JR, Sonavane SK, Snell-Bergeon J, Nath H
Coron. Artery Dis. 2015 Mar; Volume 26 (Issue 2): Pages 157-62 PUBMED