Bad News Coronary Artery Calcium in Rheumatic Patients Save

A recent presentation at the 2024 Society of Cardiovascular Computed Tomography (SCCT) meeting by Brittany Weber MD, PhD (Brigham and Women’s Hospital) has shown that incidental findings of coronary artery calcium (CAC) on chest CTs in patients with immune-mediated inflammatory diseases (IMID) may be associated with poorer outcomes, even if they don’t have preexisting atherosclerotic cardiovascular disease (ASCVD). 

In her study, an artificial intelligence (AI) algorithm looked forCAC on noncardiac, nongated chest CTs from 2,528 patients with psoriasis, SLE, or rheumatoid arthritis and no known ASCVD. They found CAC in more than half of patients with psoriasis, systemic lupus erythematosus (SLE), or rheumatoid arthritis who had undergone a prior noncardiac chest CT scan. Importantly, any amount of calcium was associated with greater risks of all-cause death and MACE (death, MI, stroke, or revascularization), although higher CAC scores had higher risks.

Only 47% having a CAC-AI score of 0. Scores of 1-99, 100-299, and 300 or more were found in 30.3%, 10.1%, and 13.0%, respectively. CAC severity was greater in patients with psoriasis.

With median follow-up of 7.4 years, the presence of any CAC increased the risk of ll-cause mortality and  MACE. : 

• CAC-AI scores of 1-99: HR 1.4 (95% CI 1.1-1.9) for all-cause mortality and HR 1.5 (95% CI 1.2-1.9) for MACE. 
• CAC-AI score of 300 or higher: HRs for both mortality and MACE 2.5 

Whether standard CV prevention therapies will work in these patients already at high risk remains to be seen, one expert says.