Coronary Artery Calcification Is Often Unreported in CT Pulmonary Angiograms in Patients With Suspected Pulmonary Embolism: An Opportunity to Improve Diagnosis of Acute Coronary Syndrome

Abstract

Objective: In patients with suspected pulmonary thromboembolism (PTE), coronary artery calcification (CAC) can be an incidental finding in CT pulmonary angiograms. We evaluated the frequency of unreported CAC and its association with diagnosis of acute coronary syndrome (ACS). Methods: The data of 469 consecutive patients who were referred to the emergency radiology department for CT pulmonary angiography because of suspicion for PTE were reviewed. Radiology reports were rechecked, and positive CAC findings were recorded. All CT pulmonary angiograms were re-evaluated by one radiologist, and CAC findings were recorded. The rate of ACS and PTE as final diagnosis for that hospital admission was calculated. The association between CAC and ACS diagnosis was assessed in different subgroups of patients. Results: About 11.1% of patients had PTE and 43.8% had CAC. CAC was significantly higher in patients with ACS diagnosis than those without (56.2% vs. 40.4%; OR = 1.9). There was a strong positive association (OR = 3.5) between CAC and ACS in younger patients (age ≤ 45 in men, age ≤ 55 in women); those without PTE (OR = 2.15); and those without cardiometabolic risk-factors (OR = 3.8). CAC was unreported in 45% of patients with positive CAC (n = 98). ACS was the final diagnosis in 31.6% of patients with unreported CAC. There was a significant association between CAC and ACS in patients with unreported CAC (OR = 2.18). This association was more prominent in the above subgroups. Conclusions: CAC is often unreported in CT pulmonary angiograms. CAC is a significant predictor of ACS, particularly in younger patients and those without PTE and cardiometabolic risk-factors. Especially in these sub-groups, radiologists should assess CAC findings.