Coronary Artery Calcium Score Predicts Cardiovascular and Transplant‐Related Outcomes in Lung Transplant Recipients

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INTRODUCTION: Current guidelines recommend evaluation for coronary artery disease prior to lung transplantation. Coronary artery calcium scores obtained using non-gated, non-contrast computed tomography scans may help predict major adverse cardiovascular events following transplant. METHODS: This retrospective analysis examined adult patients without prior coronary revascularization who underwent lung transplantation between 2009 and 2023 at a single, large tertiary-care center. Agatston coronary artery calcium scores were obtained using non-gated, non-contrast chest CT scans. Invasive coronary angiography was performed to evaluate for obstructive coronary artery disease. Major adverse cardiovascular events, defined as myocardial infarction, ischemic stroke, or all-cause death were recorded. Multiple logistic regression analysis was performed with baseline independent variables of age, sex, hypertension, hyperlipidemia, diabetes, and smoking history. RESULTS: This study included 146 patients (mean age 64.8 years, 41.8% female) who underwent lung transplantation. 10.3% of patients experienced a major adverse cardiovascular event over the median follow-up period of 4.9 years (IQR = 5.2 years). 6.2% of patients had obstructive coronary artery disease. No patient with a coronary artery score less than 100 was found to have obstructive coronary artery disease. Coronary artery calcium score severity when added to traditional risk factors demonstrated higher predictive accuracy for post-transplant major adverse cardiovascular events compared to invasive coronary angiography (AUC 0.734 vs. 0.696; baseline 0.607). CONCLUSION: Coronary artery calcium score provided important prognostic information on transplant-related outcomes. Compared to invasive coronary angiography, coronary artery calcium score was superior for predicting major adverse cardiovascular events following lung transplantation.

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