Coronary computed tomography angiography for assessing the coronary artery and predicting adverse cardiovascular events in patients with thoracic malignancies.

Background: It is unclear whether the parameters derived from coronary computed tomography angiography (CCTA) can identify the impairments of coronary arteries and if they are associated with major adverse cardiovascular events (MACEs) in patients with thoracic malignancies receiving chemotherapy or chemoradiotherapy. This study aimed to investigate the longitudinal changes in coronary arteries using CCTA and to determine their association with MACEs in patients with thoracic malignancies receiving chemotherapy or chemoradiotherapy.

Methods: This cross-sectional study included consecutive patients with thoracic malignancies who received chemotherapy or chemoradiotherapy and who underwent CCTA between June 2013 and May 2019 at Chongqing University Cancer Hospital. The pericoronary fat attenuation index (FAI) of three main coronary arteries before and after chemotherapy or chemoradiotherapy were assessed. The association between CCTA parameters and MACEs was evaluated via the Cox proportional hazards model. Kaplan-Meier survival curves were drawn to compare the MACE-free survival rates.

Results: A total of 1,543 patients were enrolled, 232 of whom developed MACEs. Among the patients, 41.3% were male, and the median age was 67.00 years (interquartile range 56.00-72.00 years). The FAI values were significantly increased after chemotherapy or chemoradiotherapy (all P values <0.05). After treatment, the FAI values were higher in the chemoradiotherapy group than in the chemotherapy group. MACEs were associated with the FAI values before chemotherapy in the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA) [LAD: hazard ratio (HR) =3.745, 95% confidence interval (CI): 1.193-11.756, P=0.023; LCX: HR =3.460, 95% CI: 1.092-10.832, P=0.031; RCA: HR =4.175, 95% CI: 1.375-12.673, P=0.011] and chemoradiotherapy (LAD: HR =2.856, 95% CI: 1.210-6.742, P=0.016; LCX: HR =2.385, 95% CI: 1.037-5.487; P=0.040; RCA: HR =2.029, 95% CI: 1.074-3.834, P=0.029).

Conclusions: The FAI derived from CCTA, as an imaging biomarker of coronary arterial inflammation, was able to characterize coronary arterial impairment, and the FAI at baseline was associated with MACEs in patients with thoracic malignancies receiving chemotherapy or chemoradiotherapy.