Coronary artery calcification predicts cardiovascular complications after sepsis


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Abstract

Purpose:Sepsis is a highly prevalent and fatal condition, with reported cardiovascular event rates as high as 25–30% at 1 year. Risk stratification in septic patients has been extremely limited.Material and methods:267 septic patients with detectable troponin levels, APACHE II scores, and CT scans of the chest or abdomen were assessed. Patients with a recent cardiac intervention were excluded. Coronary artery calcification (CAC) was identified as present or absent on body CT scans. Cardiovascular death, acute myocardial infarction (AMI), or PCI at 1 year was assessed using multivariate logistic regression analysis.Results:Patients with CAC were older, predominantly male with more risk factors for coronary disease, but similar peak troponin levels and APACHE II scores. In a multivariate analysis, CAC was predictive of the primary outcome (OR 6.827; 95% CI 1.336–54.686; p = 0.037). Patients with no CAC, history of CHF or CKD were at low risk (<1%) for cardiovascular complications at 1 year even at very high troponin levels (<8.0 ng/dL).Conclusion:CAC risk stratifies septic patients for cardiovascular complications better than traditional risk factors and can be identified on body CT scans. This novel, risk stratifying framework built on CAC can help guide individualized management of septic patients.HighlightsCardiovascular complications after sepsis are common and maybe underappreciated.CAC identifies patients at risk for cardiovascular complication and all-cause mortality after an admission for sepsis.Absence of CAC confers a low risk (≤ 1%) of acute myocardial infarction or need for revascularization at 1 year.

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