Opportunistic coronary calcium screening in patients undergoing procedural planning for catheter ablation of atrial fibrillation
Authors: Aguiar Neves A I , Leite M , Teixeira R , Nunes F , Ribeiro Silva M , Almeida M , Lobo A , Almeida J , Fonseca P , Faria R , Goncalves H , Oliveira M , Primo J , Ferreira N , Fontes-Carvalho R 
Published: June 2024

Abstract

Introduction
Coronary artery calcium score (CACS) may be a useful tool for opportunistic cardiovascular risk stratification in patients with atrial fibrillation undergoing cardiac computed tomography (CCT) for catheter ablation planning.

Methods
This cohort retrospectively included all consecutive patients who underwent CCT for ablation procedure planning between 2017 and 2021. CACS was assessed using the Agatston method. Cardiovascular risk was assessed using the SCORE algorithm for patients aged less than 70 years and the SCORE-OP algorithm for patients 70 years and older. Patients with known CAD were excluded. Clinical, analytical and procedural characteristics were collected during the follow-up period.

Results
In this cohort, a total of 709 patients (37% female; mean age 58±8 years; 13% aged ≥70 years; mean CHA2DS2VASc score 1.4±1.2; 76% paroxysmal AF) underwent CCT planning for AF catheter ablation. The mean SCORE value was 1±1.5 points, while the mean SCORE-OP value in patients aged ≥70 years was 10.9±6.1 points. Median follow-up after catheter ablation was 30 months.
In this population, 232 patients (33%) were prescribed statins, of whom 174 patients (28%) were prescribed a moderate intensity statin and 31 patients (5%) were prescribed a high intensity statin. When considering CACS, 400 patients (56%) had a CACS greater than zero, of whom 163 patients (41%) presented CACS ≥100 and 79 patients (20%) presented CACS ≥300.
Compared to patients without coronary calcification, patients with CACS greater than 0 were older (62±6.0 vs. 52±8.5 years, p&lt;0.001), had higher body mass index (27.7 vs. 26.4 kg/m2, p&lt;0.001), higher triglyceride levels (101 vs. 93 mg/dl, p=0.013), hypertension (59% vs. 33%, p&lt;0.001), dyslipidaemia (55% vs. 34%, p&lt;0.001), type 2 diabetes mellitus (18% vs. 6%, p&lt;0.001), heart failure (10% vs. 5%, p=0.006) and obstructive sleep apnoea (12% vs. 5%, p=0.003).
Patients with CACS greater than zero were more likely to be prescribed statins (51% vs. 21%, p&lt;0.001). Considering a CACS of 100 or greater as a threshold for initiating statin therapy in low to moderate risk patients, an additional 86 patients could be identified as candidates for statin therapy. Furthermore, when considering a threshold of CACS ≥300 for intensification of statin therapy, a change in statin therapy from a low or moderate-intensity statin to a high-intensity statin could be recommended in 33 patients.

Conclusions
Patients with incidental coronary calcification have an increased cardiovascular risk profile compared to those without coronary calcification, even in the absence of known coronary disease. Patients undergoing CCT for procedural planning may benefit from opportunistic calcium scoring in order to better stratify their risk profile and determine the need for intensification of medical therapy.