Achados calcificações coronárias em tomografias computadorizadas de tórax não sincronizadas por eletrocardiograma e predição de eventos cardiovasculares maiores

Abstract

Objective: To evaluate the ability of the visual coronary artery calcification score (vCAC), obtained from non-ECG-gated chest CT scans, to predict major adverse cardiovascular events (MACE) in patients aged 55 years or younger. Methods: A retrospective case-control study conducted at a tertiary hospital, including patients admitted for major cardiovascular events (cases) and for non-cardiovascular or non-MACE cardiovascular causes (controls). Clinical data, risk factors, the time between CT and hospital admission, and the presence and severity of coronary calcification assessed by both the visual method (vCAC) and the Agatston method were analyzed, along with aortic and mitral valvular calcifications. Logistic regression models were used to identify independent predictors of MACE. Results: The MACE group showed higher prevalence and severity of vCAC (63.4% vs. 17.9% in controls; p<0.001), with an adjusted OR of 6.6 (95% CI: 2.94–14.81) for event prediction. Hypertension emerged as an independent risk factor (OR=3.07; 95% CI: 1.37–6.87). Agreement between vCAC and Agatston scoring was high (Kappa=0.857; accuracy=94.5%). Conclusion: vCAC is a relevant and accessible clinical predictor of MACE in young patients undergoing non-ECG-gated chest CT, standing out as a promising screening tool for early detection of cardiovascular risk in dynamic clinical settings lacking specialized resources.