Lower limb arterial calcification (LLAC) scores in patients with symptomatic peripheral arterial disease are associated with increased cardiac mortality and morbidity

PLoS One

Jason M. Tarkin¹  James. H. F. Rudd¹  Patrick A. Coughlin²  Mohammed M. Chowdhury²  Paul D. Hayes²  Gregory C. Makris³  Francis R. Joshi⁴ 

[1] Division of Cardiovascular Medicine, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom;Division of Vascular and Endovascular Surgery, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom;Division of Vascular and Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom;Heart Center, Rigshospitalet, Copenhagen, Denmark

关键词: Calcification;    Coronary heart disease;    Computed axial tomography;    Morbidity;    Atherosclerosis;    Cardiology;    Diabetes mellitus;    Chronic kidney disease;   

DOI  :  10.1371/journal.pone.0182952

学科分类：医学（综合）

来源: Public Library of Science

【 摘 要 】

Aims The association of coronary arterial calcification with cardiovascular morbidity and mortality is well-recognized. Lower limb arterial calcification (LLAC) is common in PAD but its impact on subsequent health is poorly described. We aimed to determine the association between a LLAC score and subsequent cardiovascular events in patients with symptomatic peripheral arterial disease (PAD). Methods LLAC scoring, and the established Bollinger score, were derived from a database of unenhanced CT scans, from patients presenting with symptomatic PAD. We determined the association between these scores outcomes. The primary outcome was combined cardiac mortality and morbidity (CM/M) with a secondary outcome of all-cause mortality. Results 220 patients (66% male; median age 69 years) were included with follow-up for a median 46 [IQR 31–64] months. Median total LLAC scores were higher in those patients suffering a primary outcome (6831 vs. 1652; p = 0.012). Diabetes mellitus (p = 0.039), ischaemic heart disease (p = 0.028), chronic kidney disease (p = 0.026) and all-cause mortality (p = 0.012) were more common in patients in the highest quartile of LLAC scores. The area under the curve of the receiver operator curve for the LLAC score was greater (0.929: 95% CI [0.884–0.974]) than for the Bollinger score (0.824: 95% CI [0.758–0.890]) for the primary outcome. A LLAC score ≥ 4400 had the best diagnostic accuracy to determine the outcome measure. Conclusion This is the largest study to investigate links between lower limb arterial calcification and cardiovascular events in symptomatic PAD. We describe a straightforward, reproducible, CT-derived measure of calcification—the LLAC score.

【 授权许可】

CC BY