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Coronary artery calcification scoring system based on the coronary artery calcium data and reporting system (CAC-DRS) predicts major adverse cardiovascular events or all-cause death in patients with potentially curable lung cancer without a history of cardiovascular disease

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Abstract

The coronary artery calcium data and reporting system (CAC-DRS) is a novel reporting system based on CAC severity. Lung cancer patients have a high risk of cardiovascular disease (CVD), for which CAC severity may provide additional prognostic information. Using non-gated, non-contrast computed tomography (CT), we evaluated the CAC-DRS for predicting CVD and all-cause death in patients with potentially curable resected lung cancer. We retrospectively studied 309 consecutive patients without a history of CVD (mean age 67.4 ± 8.2 years, 61% male) who underwent curative surgery for non-small-cell lung cancer between May 2012 and March 2019 at the Japanese Red Cross Okayama Hospital. Time to incidence of major adverse cardiac events (MACEs) (non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and all-cause death was analyzed using Fine and Gray and Cox regression models. The CAC-DRS score was assessed using standard chest CT without electrocardiogram gating. During 52-months’ median follow-up, 43 patients (13.4%) developed incident MACEs or died from any cause; the pathological cancer stages were Ia (n = 20), Ib (n = 8), IIa (n = 2), IIb (n = 2) and IIIa (n = 11). Patients had a graded increase in incidence of MACEs or all-cause death with increasing categories of CAC-DRS. The CAC-DRS score was significantly associated with incident MACEs or all-cause death after adjusting for confounding factors (hazard ratio 1.18; 95% confidence interval 1.10–1.25, p < 0.01). In conclusion, the CAC-DRS score on non-gated standard CT can predict incident MACEs and/or all-cause death in patients with potentially curable resected lung cancer. Lung cancer survivors with a greater CAC-DRS category may need more active management of cardiovascular risk factors.

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Abbreviations

CAC:

Coronary artery calcification

CAC-DRS:

Coronary artery calcium data and reporting system

CT:

Computed tomography

CVD:

Cardiovascular disease

ECG:

Electrocardiogram

MACE:

Major adverse cardiovascular event

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Acknowledgements

We thank Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript. Clinical Trial Number: UMIN000035931.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-0921, Japan

    Kazuhiro Osawa, Soichiro Fuke, Asako Mizobuchi, Shunsuke Daido, Masamichi Tanaka, Akihisa Yumoto & Hironori Saito

  2. Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan

    Akihiro Bessho

  3. Department of Thoracic Surgery, Japanese Red Cross Okayama Hospital, Okayama, Japan

    Shigeharu Moriyama

  4. Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan

    Hiroshi Ito

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  1. Kazuhiro Osawa
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Contributions

KO and AB designed the study, and KO, AB and SF wrote the initial draft of the manuscript. KO, AB, SM, SD, AM, MT, AY, HS, SF and HI contributed to analyzing and interpreting the data and assisted in preparing the manuscript. All authors had full access to all data, critically revised the text, and provided final approval of the version to be published.

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Correspondence to Kazuhiro Osawa.

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Osawa, K., Bessho, A., Fuke, S. et al. Coronary artery calcification scoring system based on the coronary artery calcium data and reporting system (CAC-DRS) predicts major adverse cardiovascular events or all-cause death in patients with potentially curable lung cancer without a history of cardiovascular disease. Heart Vessels 35, 1483–1493 (2020). https://doi.org/10.1007/s00380-020-01624-x

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