Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a retrospective cohort study

AIM To assess coronary artery calcification (CAC) and vascular calcification in patients with pulmonary embolism (PE) and correlate this with mortality. MATERIALS AND METHODS PE severity was quantified using computed tomography pulmonary angiography (CTPA) in 400 consecutive cases using the modified Miller score (1–5, mild; 6–11, moderate; 12–16, severe). Right ventricle strain was assessed using the right/left ventricle diameter (RV/LV) ratio. CAC score (CACS) was assessed using a four-point scale (CACS mild 1–3, moderate 4–8, severe 9–12) for each vessel and summed to give the total CACS. Follow-up for mortality was obtained at 3 years. RESULTS PE severity was classified as mild in 48%, moderate in 21%, and severe in 32% of cases. The median modified Miller score was 6 (Interquartile range [IQR] 2, 14) and median total CACS was 2 (IQR 0, 7). All-cause mortality occurred in 128 (32%) patients. Patients with CAC were three times more likely to die than patients without CAC (Hazard ratio [HR] 2.96; 95% CI 1.84, 4.77; p CONCLUSION CACS is an independent predictor of all-cause mortality in patients with PE, and has important implications for subsequent patient management.