Courtesy of Dr Michelle Williams, this image shows coronary artery calcification in the left anterior descending coronary artery, with examples of mild (a), moderate (b), and severe (c) calcification, on computed tomography pulmonary angiogram (CTPA) images.

Coronary artery calcification is a marker of coronary artery disease as it is an important part of atherosclerotic plaques. It is usually identified on dedicated cardiac computed tomography (CT) performed with electrocardiogram gating. However, it can also be identified and quantified on routine computed tomography images performed without electrocardiogram gating, including CTPA, for non-cardiac indications. In these circumstances it can potentially identify patients with previously unknown coronary artery disease.

The prevalence and severity of coronary artery calcification was assessed in 400 patients who underwent CTPA for the assessment of pulmonary embolism. Coronary artery calcification was found to be common, occurring in 68% of patients. Patients with coronary artery calcification were three times more likely to die than patients without coronary artery calcification, after 3 years of follow-up, and coronary artery calcification was a more important predictor of long-term morality than the severity of the initial pulmonary embolism.

 

The image is taken from a recent study published in Clinical Radiology:

Williams MC, Morley NCD, Muir KC, Reid JH, van Beek EJR, Murchison JT. Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a retrospective cohort study. Clin Rad 2019; 74(12): 973.e7-973.e14.