Coronary Artery Calcium Score in a Post-Mortem Population: Feasibility and Clinical Utility

Abstract

Background: Post-mortem computed tomography (PMCT) may be considered as an adjunct to post-mortem examination. Coronary artery calcium (CAC) scores in living patients are known to reclassify cardiac risk. Methods: CAC score was calculated in a blinded manner from PMCTs of one hundred consecutive cases (18–50 years old) experiencing sudden death (ischaemic heart disease = 50, trauma/unascertained = 50). All patients subsequently underwent a post-mortem, with full cardiac results and demographics collected. Results: Cases were classified according to CAC score (CAC score 0, n = 58; CAC score 1–100, n = 17; CAC score 101–400, n = 15; CAC score >400, n = 7). CAC scores were assessable for ninety-seven cases (feasibility 97%). CAC score increased with age (p = 0.0004). Elevated CAC score correlated with pathological post-mortem cardiac changes including cardiac mass (p < 0.0001), biventricular wall thickness (p < 0.0001 left ventricle, p = 0.001 right ventricle), presence of any coronary disease (p = 0.005) and severe coronary disease (p < 0.0001). CAC score >zero had positive predictive value of 89.7% for severe coronary stenosis, and specificity of 91.5%. Sensitivity of CAC score > zero for severe stenosis was only 70%. Of cases with CAC score of zero, 25.9% had severe coronary disease (p < 0.0001). Conclusion: PM CAC scoring is highly feasible. Elevated CAC score in 18–50 years old with sudden death has high positive predictive value and specificity for coronary cause of death. However, CAC score of zero does not exclude a cardiac cause. PM CAC score assessment may be considered as a further tool to determine cause of death when there is objection to post-mortem.