Quantification of coronary artery calcium in nongated CT to predict cardiovascular events in male lung cancer screening participants: results of the NELSON study

J Cardiovasc Comput Tomogr. 2015 Jan-Feb;9(1):50-7. doi: 10.1016/j.jcct.2014.11.006. Epub 2014 Nov 20.


Objective: To evaluate the incremental prognostic value of the number and maximum volume of coronary artery calcifications over modified Agatston score strata, age, pack-years, and smoking status for predicting cardiovascular events.

Methods: A total of 3559 male current and former smokers received a CT examination for lung cancer screening. Smoking characteristics, patient demographics, and physician-diagnosed cardiovascular events were collected. Images were acquired without electrocardiography gating on 16-slice CT scanners. The association between the presence of both fatal and nonfatal cardiovascular events and the predictors was quantified using Cox proportional hazard analysis.

Results: Median follow-up period was 2.9 years. Incident cardiovascular events occurred in 186 participants. Adjusted hazard ratios for modified Agatston score strata of 1 to 10, 11 to 100, 101 to 400, and >400 were 3.39 (95% confidence interval [CI], 1.20-9.59), 6.52 (95% CI, 2.73-15.60), 6.58 (95% CI, 2.75-15.78), and 12.58 (95% CI, 5.42-29.16), respectively. Moreover, comparing the models with and without modified Agatston score strata to the model with age, pack-years, and smoking status yielded a significantly better net reclassification improvement (NRI; 27.3%; P < .0001). Adding the number of calcifications to the model with age, pack-years, smoking status, and modified Agatston score strata resulted in a slightly better NRI (1.68%; P = .0490) with a hazard ratio of 1.13 (95% CI, 1.05-1.21) per 10 calcifications. The incremental prognostic information contained in the volume of the largest calcification was not statistically significant (NRI, 0.14%; P = .3458).

Conclusion: Cardiovascular event rate increased with higher numbers of calcified lesions. The number but not maximum volume of calcifications has independent, although minimal, prognostic value over age, pack-years, smoking status, and modified Agatston score strata in our population.

Keywords: Agatston score; Cardiovascular event; Computed tomography; Coronary artery calcification; Lung cancer screening.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Artificial Intelligence
  • Belgium / epidemiology
  • Calcinosis / diagnostic imaging*
  • Calcinosis / mortality*
  • Causality
  • Comorbidity
  • Coronary Angiography / statistics & numerical data
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / mortality*
  • Early Detection of Cancer / statistics & numerical data
  • Humans
  • Incidence
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / mortality
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Radiographic Image Interpretation, Computer-Assisted / methods
  • Reproducibility of Results
  • Risk Assessment / methods
  • Sensitivity and Specificity
  • Smoking / epidemiology
  • Survival Rate
  • Tomography, X-Ray Computed / statistics & numerical data*