Coronary artery calcium score severity 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) in lung transplant recipients.
Key Findings
Results
No patient with a coronary artery calcium score less than 100 was found to have obstructive coronary artery disease.
6.2% of patients in the total cohort had obstructive coronary artery disease confirmed by invasive coronary angiography
This finding suggests a CAC score threshold of 100 may effectively rule out obstructive CAD in lung transplant candidates
The study population included 146 adult patients without prior coronary revascularization
Agatston coronary artery calcium scores were obtained using non-gated, non-contrast chest CT scans
Results
Coronary artery calcium score severity combined with traditional risk factors demonstrated superior predictive accuracy for post-transplant major adverse cardiovascular events compared to invasive coronary angiography.
AUC for CAC score plus traditional risk factors was 0.734 versus 0.696 for invasive coronary angiography
Baseline model using traditional risk factors alone yielded an AUC of 0.607
Traditional risk factors included in multiple logistic regression were age, sex, hypertension, hyperlipidemia, diabetes, and smoking history
Major adverse cardiovascular events were defined as myocardial infarction, ischemic stroke, or all-cause death
Results
10.3% of lung transplant recipients experienced a major adverse cardiovascular event over a median follow-up period of 4.9 years.
The interquartile range for follow-up was 5.2 years
The study included 146 patients with a mean age of 64.8 years, 41.8% of whom were female
Patients underwent lung transplantation between 2009 and 2023 at a single large tertiary-care center
All patients were adults without prior coronary revascularization
Results
Coronary artery calcium scores obtained from non-gated, non-contrast chest CT scans provided important prognostic information on transplant-related outcomes.
Non-gated, non-contrast CT scans are routinely performed during pre-transplant evaluation, making CAC scoring a potentially low-cost add-on assessment
Agatston scoring methodology was used to quantify coronary artery calcium
The study was a retrospective analysis of a single large tertiary-care center
CAC score severity was categorized and added as an independent variable to baseline traditional cardiovascular risk factors
What This Means
This research suggests that measuring calcium deposits in the coronary arteries using standard chest CT scans — scans already routinely performed before lung transplantation — can better predict serious heart-related complications after transplant than invasive heart catheterization procedures. The study followed 146 lung transplant patients for a median of nearly 5 years and found that about 1 in 10 experienced a major adverse cardiovascular event such as a heart attack, stroke, or death. When calcium scoring was combined with traditional risk factors like age, diabetes, and smoking history, it predicted these events more accurately (AUC 0.734) than invasive coronary angiography (AUC 0.696).
A particularly notable finding is that none of the patients with a coronary artery calcium score below 100 had obstructive coronary artery disease, suggesting this threshold could potentially help identify patients who are unlikely to need more invasive testing. Only 6.2% of patients had obstructive coronary artery disease overall, raising questions about the routine use of invasive angiography in this population.
This research suggests that incorporating calcium scoring from pre-existing CT scans into the pre-transplant evaluation process could provide clinically meaningful risk information at little or no additional cost or procedural risk to patients. It raises the possibility that calcium scoring could serve as a more practical and potentially superior tool compared to invasive testing for stratifying cardiovascular risk in lung transplant candidates, though the retrospective, single-center nature of the study means further research would be needed to confirm these findings broadly.