Calcificación arterial coronaria: comparación entre estudios gatillados y no gatillados

Patients who undergo a computed tomography (CT) scan of the chest for COPD or lung cancer detection, usually have risk factors for coronary heart disease. Since CT clearly identifies coronary calcification, it can be advantageous to detect two pathologies with great clinical impact in the same examination. In the present study, we sought to determine the correlation between the"Agatston Method", traditionally used in the evaluation of coronary calcium score (CCS) through multidetector computed  tomography (MDCT) with triggered ECG, and a "Visual Method" by Chest CT without ECG. Methods and Results: Fifty consecutive patients who underwent a chest CT scan without ECG and without contrast for chest evaluation, were recruited to undergo CCS. Dividing the coronary arterial tree into 18 segments, CCS was measured in the traditional way, through the "Agatston Method". In turn, in the "Visual Method" by CT without ECG, a point was assigned to each coronary artery segment that presented parietal calcification (defined as all coronary arterial tissue ≥130 HU and an area of lesion ≥1 mm2), being the total visual coronary calcium score (TVCCS) for each subject, the sum of all the scores obtained in the four main arteries. Results: The TVCCS was categorized as follows: absent (0), mild (1-3), moderate (4-6) and severe (≥7), intended to be consistent with Agatston scores of 0, 1-100, 101-400 and ≥401, respectively. Using the Spearman’s rank correlation coefficient, a statistically significant association was found between the "Agatston Method" and "Visual Method" variables, estimated value of correlation r = 0.97 (p<0.01). In addition, a positive correlation was observed between both methods with the Chi-square hypothesis test with an observed proportion of 0.92 (p<0.01).Conclusions: This study validates the reliability of the "Visual Method" by CT without ECG to determine the amount of coronary calcium and its correlation with the "Agatston Method". In addition, this technique should allow the stratification of the risk of coronary atherosclerotic disease in patients undergoing a chest CT scan during the evaluation of pulmonary, aortic and / or mediastinal pathologies without requiring additional scanning.