Abstract 11331: Correlations Between Coronary Artery Calcium From Non-Gated Computed Tomography and Conventional Estimates of Peri-Operative Risk by Age and Sex

Abstract

Introduction: Perioperative risk estimation prior to non-cardiac surgery is a common clinical challenge. Coronary artery calcification (CAC) is more common in men and older individuals. We sought to determine if an index of coronary calcium derived from pre-operative non-gated chest computed tomography (CT) is associated with conventional estimates of peri-operative risk in subgroups by age and sex. Methods: We retrospectively identified men and women age ≥45 years who had undergone non-cardiac surgery at a large urban health system between 2016 and 2020 and had a non-gated chest CT within 1 year prior to surgery. Coronary calcium in each coronary artery (LAD, LCX, RCA) was graded as absent, mild, moderate, or severe with a corresponding numeric score (range: 0-3). A novel coronary calcium index (CCI) was determined as the sum of these scores. Correlations between the CCI and Revised Cardiac Risk Index (RCRI), a conventional measure of perioperative risk, were assessed in subgroups by age and sex using Spearman's correlation coefficient (𝜌;). Results: Among 2,560 patients, 49.8% (1,273) were female and 60.0% (1,538) were ≥65 years old. The CCI exhibited a correlation with RCRI in men (𝜌;: 0.204, p<0.001) and women (𝜌;: 0.200, p<0.001), with no differences by sex (p=0.95). Correlations between the CCI and RCRI were also observed in younger (age 45-64 years; 𝜌;: 0.180, p<0.001) and older (age ≥65 years; 𝜌;: 0.204, p<0.001) adults, with no differences by age group (p=0.53) Conclusion: An index of coronary calcium derived from non-gated chest CT imaging prior to surgery correlated with RCRI among all subgroups by age and sex. Coronary calcium from non-gated imaging represents a potentially promising approach to pre-operative risk evaluation.