The Impact of Coronary Calcium Scores in Lung Cancer Screening

P0194 

Abstract Submission 

Parth Patel (1), Mark Shacker (1), Claire Woods (1), Artur Rybachok (1), Stephanie Gerardin (2), Cindy Stotts (2), Enise Yoo-Liu (2), Jasmine Huang (2)

(1) Creighton University School of Medicine, Phoenix, AZ, (2) Norton Thoracic Institute, Phoenix, AZ

Parth Patel    -  Contact Me
Creighton University School of Medicine

Mark Shacker    -  Contact Me
Creighton University School of Medicine

Claire Woods    -  Contact Me
Creighton University School of Medicine

Artur Rybachok    -  Contact Me
Creighton University School of Medicine

Stephanie Gerardin    -  Contact Me
Norton Thoracic Institute

Cindy Stotts    -  Contact Me
Norton Thoracic Institute

Enise Yoo-Liu    -  Contact Me
Norton Thoracic Institute

Jasmine Huang    -  Contact Me
Norton Thoracic Institute

Parth Patel    -  Contact Me
Creighton University

OBJECTIVE:
Over 800,000 individuals undergo lung cancer screening via low-dose computed tomography (LDCT) annually. Although LDCT is primarily used as a tool to screen for lung cancer, it can also provide important data about patients' cardiovascular health through the measurement of coronary calcium scores (CCS). The CCS is a measure of the total area of calcium deposits visible in the coronary arteries, with higher scores reflecting increased risk of coronary artery disease (CAD). In this study, we aimed to explore the utility of coronary calcium scores detected on LDCT during lung cancer screening.

METHODS:
We retrospectively reviewed records of patients undergoing lung cancer screening at a single institution from 11/1/2011 to 1/18/2024. Patients who underwent screening with alternate imaging modalities were excluded from the analysis. The CCS is classified into five categories based on the risk of CAD: high (>400), moderate (101-400), mild (11-100), minimal (1-10), and non-identified (0). Primary variables analyzed included patient demographics, rates of specialist referral, and the frequency of subsequent intervention. Continuous variables were presented as medians with interquartile ranges (IQR).

RESULTS:
A total of 758 patients underwent LDCT; of these, 357 (47.1%) had a reported CCS. The median CCS was 107.0 (IQR: 3.2–387.0); there were 88 (24.6%) patients with a high CCS, 67 (18.8%) with a moderate CCS, 26 (7.3%) with a mild CCS, 96 (26.9%) with a minimal CCS, and 80 (22.4%) with a non-identified CCS. Patients with a high CCS were more often male, above 60 years old, and have a history of diabetes and hypertension (p < 0.001). Additionally, patients with a high CCS were more likely to be covered by Medicare (64% vs. 49%, p = 0.015), though rates of minority race were similar (9.1% vs. 17%, p = 0.065). Of the patients with a high CCS, 26 (29.5%) were referred to a cardiologist and 33 (37.5%) had an established cardiologist and were advised to follow up with them. In this subset of patients, 6 (10.2%) underwent initiation or adjustment of medication.

CONCLUSIONS:
A significant portion of patients undergoing LDCT for lung cancer screening were found to have an elevated CCS. This finding leads to increased specialist referrals and follow-up appointments with subsequent medical intervention. LDCT can be effectively used to determine risk for coronary artery disease, especially in patients with barriers to care.

Lung Cancer