Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction
Abstract Background Emergency coronary angiogram after a cardiac arrest without ST-segment elevation myocardial infarction (STEMI) is still a matter of debate. To better select patients who may benefit from this procedure, we tested a visual coronary artery calcification (VCAC) score available in ch...
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SpringerOpen
2025-04-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-025-01423-5 |
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| author | Maxence Brunel Brahim Harbaoui Laurent Bitker Carole Chambonnet Matthieu Aubry Loïc Boussel Cyril Besnard Jean-Christophe Richard Pierre Lantelme Pierre-Yves Courand |
| author_facet | Maxence Brunel Brahim Harbaoui Laurent Bitker Carole Chambonnet Matthieu Aubry Loïc Boussel Cyril Besnard Jean-Christophe Richard Pierre Lantelme Pierre-Yves Courand |
| author_sort | Maxence Brunel |
| collection | DOAJ |
| description | Abstract Background Emergency coronary angiogram after a cardiac arrest without ST-segment elevation myocardial infarction (STEMI) is still a matter of debate. To better select patients who may benefit from this procedure, we tested a visual coronary artery calcification (VCAC) score available in chest CT to predict significant coronary artery stenosis and/or culprit lesion or ad hoc or delayed percutaneous coronary intervention (PCI). Results A total of 113 patients with cardiac arrest and without STEMI who had a coronary angiogram and chest CT (January 2013 to March 2023, Croix-Rousse Hospital, Lyon, France) were retrospectively included. VCAC was scored from 0 (no calcification) to 3 (diffuse calcification) for each 4 four main arteries (left main, left anterior descending, circumflex, and right coronary artery). At baseline the median [interquartile range] age was 65.8 years [53.4–75.7], 61.9% were male, and 59.3% presented with ventricular fibrillation. Coronary angiogram identified at least one significant coronary artery stenosis in 32.7%, and ad hoc and delayed PCI were performed in 12.4% and 6.2% of the patients, respectively. VCAC score was an excellent predictor of significant coronary artery stenosis with an area under the ROC curve (AUC) of 0.95 (95%CI [0.90-1.00]) and the optimal threshold was ≥ 4 (specificity 94.7%, sensitivity 91.9%). For the detection of culprit coronary artery stenosis, the AUC was at 0.90 (95%CI [0.85–0.96]) and the optimal threshold was ≥ 5 (specificity 83.5%, sensitivity 87.5%). The AUC was 0.886 [0.823–0.948] (specificity 81.8%, sensitivity 85.7%) for ad hoc PCI and 0.921 [0.872–0.972] (specificity 85.3%, sensitivity 88.9%) for both delayed and ad hoc PCI with a same optimal threshold of VCAC ≥ 5. A VCAC score ≥ 4 had a sensitivity at 100% to predict a significant or culprit coronary artery stenosis and ad hoc or delayed PCI. Conclusions The present study found that a non-dedicated CT thorax may be useful to measure VCAC and if this is scored ≥ 4 it allows physicians to better select patients resuscitated from cardiac arrest with non-STEMI and without history of coronary artery disease who may benefit from an emergency coronary angiogram to detect a significant or culprit coronary artery stenosis and had PCI if appropriate. |
| format | Article |
| id | doaj-art-b7952e0ab9be4d6183ecbce74c9a10b7 |
| institution | OA Journals |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | SpringerOpen |
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| series | Annals of Intensive Care |
| spelling | doaj-art-b7952e0ab9be4d6183ecbce74c9a10b72025-08-20T02:11:42ZengSpringerOpenAnnals of Intensive Care2110-58202025-04-0115111110.1186/s13613-025-01423-5Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarctionMaxence Brunel0Brahim Harbaoui1Laurent Bitker2Carole Chambonnet3Matthieu Aubry4Loïc Boussel5Cyril Besnard6Jean-Christophe Richard7Pierre Lantelme8Pierre-Yves Courand9Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de LyonFédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de LyonUniversité de Lyon, CREATIS; CNRS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de LyonFédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de LyonUniversité de Lyon, CREATIS; CNRS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1Service de cardiologie, Hôpital Nord-OuestUniversité de Lyon, CREATIS; CNRS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de LyonFédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de LyonAbstract Background Emergency coronary angiogram after a cardiac arrest without ST-segment elevation myocardial infarction (STEMI) is still a matter of debate. To better select patients who may benefit from this procedure, we tested a visual coronary artery calcification (VCAC) score available in chest CT to predict significant coronary artery stenosis and/or culprit lesion or ad hoc or delayed percutaneous coronary intervention (PCI). Results A total of 113 patients with cardiac arrest and without STEMI who had a coronary angiogram and chest CT (January 2013 to March 2023, Croix-Rousse Hospital, Lyon, France) were retrospectively included. VCAC was scored from 0 (no calcification) to 3 (diffuse calcification) for each 4 four main arteries (left main, left anterior descending, circumflex, and right coronary artery). At baseline the median [interquartile range] age was 65.8 years [53.4–75.7], 61.9% were male, and 59.3% presented with ventricular fibrillation. Coronary angiogram identified at least one significant coronary artery stenosis in 32.7%, and ad hoc and delayed PCI were performed in 12.4% and 6.2% of the patients, respectively. VCAC score was an excellent predictor of significant coronary artery stenosis with an area under the ROC curve (AUC) of 0.95 (95%CI [0.90-1.00]) and the optimal threshold was ≥ 4 (specificity 94.7%, sensitivity 91.9%). For the detection of culprit coronary artery stenosis, the AUC was at 0.90 (95%CI [0.85–0.96]) and the optimal threshold was ≥ 5 (specificity 83.5%, sensitivity 87.5%). The AUC was 0.886 [0.823–0.948] (specificity 81.8%, sensitivity 85.7%) for ad hoc PCI and 0.921 [0.872–0.972] (specificity 85.3%, sensitivity 88.9%) for both delayed and ad hoc PCI with a same optimal threshold of VCAC ≥ 5. A VCAC score ≥ 4 had a sensitivity at 100% to predict a significant or culprit coronary artery stenosis and ad hoc or delayed PCI. Conclusions The present study found that a non-dedicated CT thorax may be useful to measure VCAC and if this is scored ≥ 4 it allows physicians to better select patients resuscitated from cardiac arrest with non-STEMI and without history of coronary artery disease who may benefit from an emergency coronary angiogram to detect a significant or culprit coronary artery stenosis and had PCI if appropriate.https://doi.org/10.1186/s13613-025-01423-5Cardiac arrestSudden cardiac deathVentricular fibrillationMyocardial infarctionCoronary artery calcification |
| spellingShingle | Maxence Brunel Brahim Harbaoui Laurent Bitker Carole Chambonnet Matthieu Aubry Loïc Boussel Cyril Besnard Jean-Christophe Richard Pierre Lantelme Pierre-Yves Courand Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction Annals of Intensive Care Cardiac arrest Sudden cardiac death Ventricular fibrillation Myocardial infarction Coronary artery calcification |
| title | Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction |
| title_full | Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction |
| title_fullStr | Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction |
| title_full_unstemmed | Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction |
| title_short | Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction |
| title_sort | visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without st segment elevation myocardial infarction |
| topic | Cardiac arrest Sudden cardiac death Ventricular fibrillation Myocardial infarction Coronary artery calcification |
| url | https://doi.org/10.1186/s13613-025-01423-5 |
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