1859. Impact of Total Cumulative Pack-Years of Tobacco Abuse on Coronary Artery Calcium Scores on LDCT Lung Cancer Screens
Authors * Denotes Presenting Author
  1. Anup Sanghvi; Virginia Commonwealth University School of Medicine
  2. Tyler Cook *; Virginia Commonwealth University School of Medicine
  3. Asem Rahman; Virginia Commonwealth University Health System
  4. Hassan Elzein; Virginia Commonwealth University Health System
  5. Leila Gharai; Virginia Commonwealth University Health System
  6. Mark Parker; Virginia Commonwealth University Health System
Low-dose CT (LDCT) lung cancer screening may detect unsuspected coronary artery calcifications (CACs). We developed a qualitative CAC scoring system as part of our lung cancer screening program. The purpose of this study is to determine a potential relationship between the total cumulative pack-years of smoking and increased total CAC-scores and left main (LM) scores.

Materials and Methods:
Following Institutional Review Board approval, we conducted a retrospective review of LDCT scans performed in our screening program between January 2013 and June 2021. Age, sex, smoking status, pack-years, CAC, and M-score were acquired from electronic medical records. Our thoracic radiologists applied a qualitative CAC-scoring system (0-3) on LDCT studies. Score: 0: no calcifications. Score 1: <1/3 the vessel length affected. Score 2: >1/3 but <2/3 the vessel length affected. Score 3: >2/3 the vessel length affected. The maximum possible score for 4 epicardial vessels: 12/12. Scores >4 were considered potentially clinically significant. Results were collected and analyzed from 984 participants over 9-years, producing a total of 1857 observations, with a portion of patients having multiple visits.

Mean patient age was 66.2 ± 6.8 years. Mean cumulative pack-years was 51.7 ± 22.4. A significant relationship was found between the total CAC-score and total pack-years (F12,1120 = 4.16, p < 0.0001) and between the LM-score and total pack-years (F3,1181) = 4.96, p = 0.0020). Posthoc tests indicate that significant differences exist between an LM-score of 0 and 2, as well as 0 and 3, and 1 and 3; no other comparisons were different. In both cases, a direct correlation was discovered.

Our study shows a direct correlation between total-pack years if smoking and total qualitative CAC and LM-scores. CAC increases with advancing age and tobacco use leading to increased morbidity and mortality. LDCT can qualitatively assess CACs. Given the increased morbidity and mortality associated with CACs, our system could be routinely used in the LungRADS reporting system as an “S” finding.