The value of coronary artery calcium scores based on non-gated chest CT in predicting perioperative cardiovascular risk in patients with lower-risk lung cancer surgery

Abstract

Abstract Objectives This study evaluated whether coronary artery calcium scores (CACS) that were measured with non-gated chest CT predicted perioperative cardiovascular events in patients who were undergoing lower-risk lung cancer surgery. Method In this retrospective single center study, we evaluated 3112 consecutive lung cancer patients with non-gated chest CT before low-medium risk surgeries in 2017. We measured CACS and assessed clinical risk factors according to the revised cardiac risk index (RCRI) scores and predictable surgery factors. Perioperative cardiovascular events were defined as cardiac death, acute coronary syndrome, pulmonary edema, atrial and ventricular arrhythmia with hemodynamic compromise, and complete heart block during hospitalization. Result 83 patients (2.7%) had perioperative cardiac events, 71 (85.5%) of them were atrial fibrillation. Coronary calcification CT findings were seen in 761 (24.5%) patients. CACS were associated with incidence of cardiac events (p<0.001). In the receiver-operating characteristic (ROC) curve analysis of CACS for prediction of cardiac events, the cutoff value was 1 (sensitivity, 0.60; specificity, 0.75; area under the curve, 0.680). In the multivariate analysis, CACS >1 (OR=1.75, 95% CI: 1.08–2.84, p=0.023), age (OR=1.06, 95% CI: 1.03–1.10, p<0.001), pulmonary function classification (p<0.001) and thoracotomy (OR=3.06, 95% CI: 1.78–5.26, p<0.001) were predictive of cardiovascular complications. Conclusion Predicative value of CACS based on non-gated chest CT is high for perioperative cardiovascular risk in lung cancer patients with lower-risk lung surgery. It may be considered as a valuable tool for preoperative risk assessment in these patients without additional testing. Funding Acknowledgement Type of funding source: None