Incidence, Risk Factors, and Patient Management of Incidental Coronary Artery Calcification on Non-ECG Gated Computed Chest Tomography: A Systematic Review

Coronary artery calcification (CAC) is an independent predictor of cardiovascular events and can be reliably detected on non-Electrocardiogram (ECG) gated computed tomography (CT) scans. The increased use of CT has made CAC a common incidental finding, although the frequency remains variable in published literature. We aimed to identify the incidence of CAC found on routine non-ECG gated CT scans, risk factors associated with these findings, and management outcomes that resulted from discovery of CAC. A systematic review was conducted through literature search using predetermined search criteria. Applicable studies were screened by 3 investigators for eligibility. Data regarding indication for CT imaging, presence of CAC, cardiovascular risk factors, and management outcomes was collected. A total of 3585 study subjects were included for review. CAC was found in 31.2% (n = 1118) patients. Indications for CT imaging were 33.0% lung cancer screening, 16.0% for intrapulmonary pathology, and 50.0% for other reasons. In patients with CAC, the average age was 61.5 + 8.8 years old, 77.2% were male, 41.4% were smokers, 32.2% had hypertension, 31.5% had hyperlipidemia, and 11.2% had diabetes. Patients with CAC were older (p < 0.001), more likely to be smokers (p = 0.002), and more likely to have hyperlipidemia (p < 0.001). The presence of CAC in reports did not significantly alter management plans. In conclusion, traditional cardiovascular risk factors are associated with incidental CAC. Not reporting incidental CAC is a missed opportunity for identification of patient at increased risk of cardiovascular events in the community.