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Prognostic importance of coincidental coronary artery calcification on FDG-PET/CT oncology studies

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Abstract

Coronary artery calcification (CAC) on body CT imaging is considered a coincidental finding in cancer patients. In order to determine the significance of CAC in cancer patients we evaluated the prognostic utility of CAC detected on oncology FDG-PET/CT studies. A retrospective study was performed of consecutive FDG-PET/CT studies from January to March 2011. CAC was identified on the CT portion of FDG/PET-CT studies. Chart review documented statin use, the Framingham risk score (FRS) (includes age, diabetes, hypertension, dyslipidemia and smoking), the primary malignancy and metastases. The primary end point was a composite of death and cardiovascular (CV) events (non-fatal myocardial infarction (MI), PCI or coronary artery bypass surgery (CABG)). 266 patients had a median follow up of 41 months (95% CI 31–56 months). CAC was noted in 140 patients. Based on CAC, potentially 84 patients would have had a change in statin prescribing (p < 0.01). CAC was associated with the primary end point on univariable and multivariable analysis (OR 2.6 (95% CI 1.42–4.77) (p < 0.01). On univariable Kaplan–Meier survival analysis, CAC was associated with decreased survival only in the absence of metastases (p < 0.01). Cox proportional hazard modelling demonstrated CAC was associated with mortality and cardiac events in patients without metastases, whereas FRS was not (For CAC: HR 1.69 (95% CI 1.22–2.35), p = 0.002). CAC is commonly detected with oncology FDG-PET/CT. In cancer patients CAC was associated with an increased risk of clinical events. CAC reduced survival free time in patients without metastases. CAC might therefore be considered more than a coincidentaloma in patients without metastases.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Canada

    Huda El Mais, Robert Kay, Terrence Ruddy, Rob S. Beanlands, Andrew M. Crean, Benjamin J. W. Chow & Gary R. Small

  2. Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, Canada

    Hassan Almubarak & Eugene C. Y. Leung

  3. University of Ottawa Medical School, Ottawa, Canada

    Jennifer M. Rowe

  4. Medical School, Royal College of Physicians, Dublin, Ireland

    Alyssa L. S. Chow

  5. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Gary R. Small

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  1. Huda El Mais
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  2. Robert Kay
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  3. Hassan Almubarak
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  4. Jennifer M. Rowe
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  11. Gary R. Small
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by HEM, GRS, RK, JMR, ALSC. The first draft of the manuscript was written by GRS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gary R. Small.

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Conflict of interest

Dr Rob S Beanlands is a consultant with Jubilant DRAX-Image and has received grant funding from a government/industry program (partners: GE Healthcare, Nordion, Lantheus Medical Imaging, DRAX-Image) no other potential conflicts of interest relevant to this article exist. Dr Terrence D. Ruddy receives grant funding from GE Healthcare and Advanced Accelerator Applications International, no other potential conflicts of interest relevant to this article exist. Dr. Benjamin JW Chow has received research and educational support from TeraRecon; and has investment equity in GE, no other potential conflicts of interest relevant to this article exist. For the remaining authors, no other potential conflicts of interest relevant to this article exist.

Ethical approval

Permission for this single center retrospective study was approved by the Ottawa Health Science Network Research Ethics Board Protocol 20180478-01H.

Informed consent

The need for informed consent was waived by the Ottawa Health Science Network Research Ethics Board Protocol 20180478-01H. The need for informed consent was waived by the Ottawa Health Science Network Research Ethics Board Protocol 20180478-01H.

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Mais, H.E., Kay, R., Almubarak, H. et al. Prognostic importance of coincidental coronary artery calcification on FDG-PET/CT oncology studies. Int J Cardiovasc Imaging 37, 1479–1488 (2021). https://doi.org/10.1007/s10554-020-02111-0

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  • DOI: https://doi.org/10.1007/s10554-020-02111-0

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