Risk assessment of acute pulmonary embolism utilizing coronary artery calcifications in patients that have undergone CT pulmonary angiography and transthoracic echocardiography

To evaluate the relation of coronary artery calcifications (CAC) on non-ECG-gated CT pulmonary angiography (CTPA) with short-term mortality in patients with acute pulmonary embolism (PE).

We retrospectively included all in-patients between May 2007 and December 2014 with an ICD-9 code for acute PE and CTPA and transthoracic echocardiography available. CAC was qualitatively graded as absent, mild, moderate, or severe. Relations of CAC with overall and PE-related 30-day mortality were assessed using logistic regression analyses. The independence of those relations was assessed using a nested approach, first adjusting for age and gender, then for RV strain, peak troponin T, and cardiovascular risk factors for an overall model.

Four hundred seventy-nine patients were included (63 ± 16 years, 52.8% women, 47.2% men). In total, 253 (52.8%) had CAC—mild: 143 (29.9%); moderate: 89 (18.6%); severe: 21 (4.4%). Overall mortality was 8.8% (n = 42) with higher mortality with any CAC (12.6% vs. 4.4% without; odds ratio [OR] 3.1 [95%CI 2.1–14.5]; p = 0.002). Mortality with severe (19.0%; OR 5.1 [95%CI 1.4–17.9]; p = 0.011), moderate (11.2%; OR 2.7 [95%CI 1.1–6.8]; p = 0.031), and mild CAC (12.6%; OR 3.1 [95%CI 1.4–6.9]; p = 0.006) was higher than without. OR adjusted for age and gender was 2.7 (95%CI 1.0–7.1; p = 0.050) and 2.6 (95%CI 0.9–7.1; p = 0.069) for the overall model. PE-related mortality was 4.0% (n = 19) with higher mortality with any CAC (5.9% vs. 1.8% without; OR 3.5 [95%CI 1.1–10.7]; p = 0.028). PE-related mortality with severe CAC was 9.5% (OR 5.8 [95%CI 1.0–34.0]; p = 0.049), with moderate CAC 6.7% (OR 4.0 [95%CI 1.1–14.6]; p = 0.033), and with mild 4.9% (OR 2.9 [95%CI 0.8–9.9]; p = 0.099). OR adjusted for age and gender was 4.2 (95%CI 0.9–20.7; p = 0.074) and 3.4 (95%CI 0.7–17.4; p = 0.141) for the overall model. Patients with sub-massive PE showed similar results.

CAC is frequent in acute PE patients and associated with short-term mortality. Visual assessment of CAC may serve as an easy, readily available tool for early risk stratification in those patients.