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ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1511358
The Role of Coronary Artery Calcium Scoring in Prediction of Coronary Artery Disease Based on Noncontrast Noncardiac Chest CT Scans in Airline Pilots
Provisionally accepted
LIN ZHANG 1
Li Li Liu 2 Zheng Bin Zhu 2 Yan Xu 1 Yu Kai Chen 1 Qing Qing Duan 1 Kai Yu Li 1 Jie Gao 1 Meng Song 1 Qiu Yu Shen 1 Shao Jie Zhu 1 Qing Qing Jin 1 Jian Ping Wen 1 Shuo Feng 2 Ying Lu 3 Run Du 2* Bin Ren 1*
Rui Yan Zhang 2*- 1 CAAC East China Aviation Personnel Medical Appraisal Center, Civil Aviation Shanghai Hospital, Shanghai, China
- 2 Department of Cardiovascular medicine, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai, China
- 3 Department of Aviation Health, China Eastern Airlines Co., Ltd, Shanghai, China
Background: To explore the value of coronary artery calcium score (CACS) by nongated, non-contrast chest computed tomography (NCCT) in predicting the coronary artery disease (CAD) in airline Pilots.Pilots with coronary calcification found on NCCT were consecutively enrolled into this study. All received coronary computed tomography angiography (CCTA) examination. Coronary artery calcium score (CACS) was evaluated on NCCT using the Agatston method. CCTA images were analyzed by using a semiautomated software. Coronary Artery Disease Reporting and Data System (CAD-RADS) scoring categorized coronary stenosis.Results: A total of 217 male pilots were included, of which 49 were diagnosed with significant CAD (CAD-RADS category 3 or higher). Pilots with significant CAD had much higher CACS (324.28±389.02 vs. 39.16±68.88, P<0.001). Plaque volumetric measurements showed that total plaque volume (1103.50 ± 285.51mm 3 vs. 913.18 ± 277.45mm 3 , p<0.001) and calcified plaque volume (149.77 ± 160.71mm 3 vs. 36.42 ± 26.86mm 3 , p<0.001) were more pronounced in significant CAD group than those in non-significant CAD group. Multivariate analysis demonstrated that CACS (OR 1.01; 95%CI 1.005-1.014, P<0.001) was the only independent risk factor of significant CAD but no other traditional cardiovascular risk factors, pre-existing medication regimens and prolonged flight duration. CACS positively correlated with total plaque volume (r=0.156 p=0.027) and calcified plaque volume (r=0.434, p<0.001). ROC curve analysis showed the area under the curve for the CACS in 4 diagnosing significant CAD was 0.891 (p<0.001).Conclusions: CACS assessed by NCCT was significantly associated with CAD-RADS category 3 or higher, as confirmed by CCTA, which indicates that it may serve as a robust predictor for diagnosing significant CAD among airline pilots.
Keywords: non-contrast, not-gated computed tomography (NCCT), Cardiac computed tomography angiography (CCTA), Coronary artery calcium score (CACS), agatston, airline pilots
Received: 14 Oct 2024; Accepted: 31 Mar 2025.
Copyright: © 2025 ZHANG, Liu, Zhu, Xu, Chen, Duan, Li, Gao, Song, Shen, Zhu, Jin, Wen, Feng, Lu, Du, Ren and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Run Du, Department of Cardiovascular medicine, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai, China
Bin Ren, CAAC East China Aviation Personnel Medical Appraisal Center, Civil Aviation Shanghai Hospital, Shanghai, China
Rui Yan Zhang, Department of Cardiovascular medicine, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai, China
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