Background Coronary artery calcium (CAC) identified on non-gated CT scan of the chest is predictive of major adverse cardiac events (MACE) in multiple studies with guidelines therefore recommending the routine reporting of incidental CAC. These studies have been limited however to the outpatient setting. We aimed to determine the prognostic utility of incidentally identified CAC on CT scan of the chest among hospital inpatients. Methods and results Consecutive patients (n=740) referred for inpatient non-contrast CT scan of the chest at a tertiary referral hospital (January 2011 to March 2017) were included (n=280) if they had no known history of coronary artery disease, active malignancy or died within 30 days of admission. Scans were assessed for the presence of CAC by visual assessment and quantified by Agatston scoring. Median age was 69 years (IQR: 54–82) and 51% were male with a median CAC score of 7 (IQR 0–205). MACE occurred in 140 (50%) patients at 3.5 years median follow-up including 98 deaths. Half of all events occurred within 18 months. Visible CAC was associated with increased MACE (HR) 6.0 (95% CI: 3.7 to 9.7) compared with patients with no visible CAC. This finding persisted after adjusting for cardiovascular risk factors HR 2.4 (95% CI: 1.3 to 4.3) and with both absolute CAC score and CAC score ≥50th percentile. Conclusion Incidental CAC identified on CT scan of the chest among hospital inpatients provides prognostic information that is independent of cardiovascular risk factors. These patients may benefit from aggressive risk factor modification given the high event rate in the short term. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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胸部非增强 CT 扫描中偶然发现的冠状动脉钙可预测住院患者的主要心脏不良事件

背景 在多项研究中，胸部非门控 CT 扫描确定的冠状动脉钙 (CAC) 可预测主要不良心脏事件 (MACE)，因此指南建议常规报告偶发 CAC。然而，这些研究仅限于门诊环境。我们旨在确定在住院患者胸部 CT 扫描中偶然发现的 CAC 的预后效用。方法和结果 连续患者（n=740）在三级转诊医院（2011 年 1 月至 2017 年 3 月）进行胸部非增强 CT 扫描，如果他们没有已知的冠状动脉疾病史，则被纳入（n=280） 、活动性恶性肿瘤或入院后 30 天内死亡。通过视觉评估评估扫描是否存在 CAC，并通过 Agatston 评分进行量化。中位年龄为 69 岁（IQR：54-82），51% 为男性，中位 CAC 评分为 7（IQR 0-205）。在中位随访 3.5 年时，140 名（50%）患者发生 MACE，其中 98 人死亡。一半的事件发生在 18 个月内。与没有可见 CAC 的患者相比，可见 CAC 与增加的 MACE (HR) 6.0 (95% CI: 3.7 至 9.7) 相关。在调整心血管危险因素 HR 2.4（95% CI：1.3 至 4.3）并且绝对 CAC 评分和 CAC 评分≥50% 后，这一发现仍然存在。结论 住院患者胸部 CT 扫描发现的偶发 CAC 提供了独立于心血管危险因素的预后信息。鉴于短期内的高事件率，这些患者可能会受益于积极的风险因素修改。