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Intracranial arterial calcifications as a prognostic factor for subsequent major adverse cardiovascular events (MACE)

  • NEURORADIOLOGY
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Abstract

Background

Intracranial arterial calcifications (ICAC) are often detected on unenhanced CT of patients with an age > 60. However, association with the subsequent occurrence of major adverse cardiovascular events (MACE) has not yet been evaluated.

Purpose

This study aimed at evaluating the association of ICAC with subsequent MACE and overall mortality.

Methods

In this retrospective, IRB approved study, we included 175 consecutive patients (89 males, mean age 78.3 ± 8.5 years) of age > 60 years who underwent an unenhanced CT of the head due to minor trauma or neurological disorders. Presence of ICAC was determined in seven intracranial arteries using a semi-quantitative scale, which resulted in the calcified plaque score (CPS). Clinical follow-up information was obtained by questionnaires and telephone interviews. MACE was defined as myocardial infarction or revascularization, stroke or death due to cardiovascular event.

Results

Mean follow-up time was 39.8 ± 7.8 months, resulting in 579.7 patient-years of follow-up. Overall, 36 MACE occurred during follow-up (annual event rate = 6.2%/year). Mean CPS was significantly higher in subjects with MACE during follow-up compared to subjects without MACE (p < 0.01). In 15 patients CPS was 0; in none of these patients MACE was registered. Kaplan–Meier-analysis revealed that patients with a low plaque burden (CPS < 5) had a significant longer MACE-free and overall survival than patients with a high plaque burden (CPS ≥ 5) (p < 0.01).

Conclusion

Patients with ICAC have an increased risk for future cardio- or cerebrovascular events. Therefore, ICAC might be a prognostic factor to determine the risk for these events in older patients.

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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 Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany

    Frederik F. Strobl, Beatrice Kuhlin, Robert Stahl, Bastian O. Sabel, Andreas D. Helck, Andreas Schindler, Fabian Bamberg, Maximilian F. Reiser & Tobias Saam

  2. Internal Medicine IV, Division of Rheumatology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany

    Matthias Witt

  3. Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany

    Fabian Bamberg

Authors
  1. Frederik F. Strobl
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  2. Beatrice Kuhlin
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  3. Robert Stahl
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  4. Bastian O. Sabel
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  5. Andreas D. Helck
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  10. Tobias Saam
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Corresponding author

Correspondence to Frederik F. Strobl.

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All authors declare that there is no conflict of interest.

Ethical standards

Our institutional review board gave approval for this study under the number 448-12. All human studies have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients or their relatives gave informed consent prior to inclusion in this study.

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Strobl, F.F., Kuhlin, B., Stahl, R. et al. Intracranial arterial calcifications as a prognostic factor for subsequent major adverse cardiovascular events (MACE). Radiol med 123, 456–462 (2018). https://doi.org/10.1007/s11547-018-0856-9

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  • DOI: https://doi.org/10.1007/s11547-018-0856-9

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