Use of Computed Tomography Coronary Calcium Score for Prediction of Cardiovascular Events in Cancer Patients: A retrospective cohort analysis

Abstract

Abstract Background:CT- coronary calcium score, is one of the most studied and widely available modalities in cardiovascular medicine. Coronary artery calcium score (CACS) is an established predictor of coronary artery disease. The ‘standard of care’ diagnostic modality to measure CACS is ECG-gated Cardiac Multi-Detector Computed Tomography. There is convincing evidence of a strong association between CACS and major cardiovascular (CV) outcomes in asymptomatic individuals. Cancer patients (C) may have a higher risk for CV disease than non-cancer patients (NC) related not only to cancer treatments but also to shared biological factors and pathways. Thus, identifying tools for early detection of CV disease in this population is of utmost importance. Methods:A retrospective cohort analysis was performed with patients from Cleveland Clinic Florida and Ohio from 2017 to 2021. Patients who had CACS were identified, C who had cancer diagnosis before CACS were matched to age, sex with NC. CV events were compared between cancer and non-cancer patients after their index CACS, and matched control and propensity analysis were conducted. Results: 10,742 patients had CACS; 703 cancer patients had CACS and were were eligible. Extensive CACS (>400) were significantly higher in cancer, 94 (13.37 %) vs non-cancer patients, 76 (10.83%), P= <0.01. Furthermore, after propensity matched analysis, CACS > 400 was 14.8 % in C vs 9.6 % in NC, P= <0.05. CV events were similar in both cohorts (p=NS), despite less CV risk factors in cancer patients. (P=<0.05). For the combined moderate (101-400) & extensive (>400) CACS, the prevalence of Stroke and peripheral arterial disease, a marker of systemic atherosclerosis, was significantly higher in patients with cancer (P<0.01). Conclusions: Despite having fewer CV risk factors in our study, similar CACS in cancer patients are suggestive of a higher prevalence of CV disease independent of traditional risk factors. High CACS and the overall prevalence of vascular events were more frequent in patients with cancer. Higher prevalence of peripheral arterial disease and cerebrovascular accident further suggests the increased atherosclerotic burden in C.