Using Quantified Coronary Artery Calcification Scores on CT Lung Screening to Identify Populations for Early Intervention and Risk Reduction

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Abstract Rationale: Coronary artery disease (CAD) is a major cause of morbidity and mortality. Elevated coronary artery calcium (CAC) levels are common among individuals eligible for CT lung screening (CTLS), Agatston scores >400 indicate high CAD risk. Identifying CAC on CTLS offers an opportunity to detect high-risk individuals who may benefit from closer monitoring and targeted interventions. This study explored associations between Agatston scores >400, adverse outcomes and modifiable risk factors. Methods: This retrospective, multi-center CTLS cohort study included 4,673 patients from Lahey Hospital and Medical Center (LHMC) and 1,271 scans from Mount Auburn Hospital (MAH). Baseline scans (2012-2017 at LHMC; 2015-2019 at MAH) utilized the 4DMedical CAC algorithm to calculate Agatston scores. Follow-up extended through 2019 at LHMC and 2020 at MAH. A subset of 1,384 LHMC and 419 MAH patients with Agatston scores >400 and primary care within the health system were analyzed for risk factor modification and gender disparities. Chi-square tests examined group differences, and Cox proportional hazards models assessed associations with mortality, lung cancer incidence, and hospital admissions (all-cause, myocardial infarction, and congestive heart failure), with significance at p < 0.05. Results: Of the scans, 4,637 (99.2%) at LHMC and 1,251 (98.4%) at MAH successfully generated Agatston scores. A score >400 was associated with increased lung cancer risk at both LHMC (HR 2.11, CI 1.19-3.73, p = 0.01) and MAH (HR 1.75, CI 1.03-2.96, p = 0.037), and correlated with all-cause hospitalization at LHMC (HR 3.16, CI 1.43-6.99, p = 0.004) and MAH (HR 1.70, CI 1.17-2.48, p = 0.005). High scores were also linked to greater myocardial infarction events at LHMC (HR 2.8, CI 1.47-5.27, p = 0.002) and MAH (HR 2.8, CI 1.2-6.7, p = 0.017), as well as congestive heart failure admissions at LHMC (HR 1.99, CI 2.17-3.39, p = 0.011) and MAH (HR 7.87, CI 2.84-21.8, p < 0.001). Among those with Agatston scores >400, tobacco use was prevalent in 49% at LHMC and 58% at MAH. Elevated LDL (>100 mg/dL) was more common in women than men at both LHMC (55.2% vs. 40.25%, p < 0.001) and MAH (38.5% vs. 27.8%, p = 0.028). Conclusion: An Agatston score >400 on CTLS exams reliably indicates elevated risks for adverse outcomes. Targeted interventions, including smoking cessation and LDL management, are essential, with gender disparities in LDL among women warranting focused attention to improve outcomes in this high-risk group.

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