{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T16:31:00Z","timestamp":1764865860740,"version":"3.46.0"},"reference-count":41,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: While the 2024 ESC Guidelines provide guidance on utilising incidental CAC findings from non-gated CT scans to enhance risk stratification and guide treatment decisions, there remain gaps in detailed protocols for managing such incidental findings, particularly in inpatient settings. An incidental finding of CAC in a patient without known atherosclerosis provides an opportunity to assess cardiac risk, promote risk factor optimisation and evaluate need for further cardiac work up. The aim of this study was to assess the prevalence of incidental coronary artery calcification on non-cardiac dedicated gated CT thorax scans among general medical inpatients and to evaluate the subsequent management of these findings. Methods: This was a single-centre retrospective observational study of consecutive general medical inpatients aged 40\u201375, who had undergone a non-cardiac gated CT thorax during their admission, between February and March 2025. Data were collected using local electronic health records. Exclusion criteria were patients with known ischaemic heart disease (IHD). Risk factor assessment was noted by documentation of smoking status, hypertension, diabetes and low-density lipoprotein (LDL) values. Results: A total of 186 patients with thoracic CT scans were identified. On review of all CT reports, 53 (28.4%) patients had CAC reported, of whom 17 had known IHD. Therefore 36 (19.4%) patients were identified for further analysis. An exercise stress test was booked in none of the patients. A coronary angiogram was booked in 1 patient. Conclusions: One fifth of medical inpatients in our study had a new finding of CAC on thoracic imaging. Cardiovascular risk factors of LDL and HbA1c were checked in less than half of patients. None of these patients went on to have functional testing. There is a valuable opportunity to optimise cardiac risk factors and evaluate the need for functional testing in a subset of patients with CAC reported on non-cardiac CTs. This can be facilitated by raising awareness and implementing a flowchart tool for hospital physicians to reference.<\/jats:p>","DOI":"10.3390\/jcdd12120480","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T16:07:38Z","timestamp":1764864458000},"page":"480","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Coronary Artery Calcification on Non-Cardiac Gated CT Thorax Scans: A Single Tertiary Centre Retrospective Observational Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6926-5341","authenticated-orcid":false,"given":"Robert S.","family":"Doyle","sequence":"first","affiliation":[{"name":"Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 WXC8 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Divyanshu","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 WXC8 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Devitt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 WXC8 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Hartnett","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 WXC8 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9151-3431","authenticated-orcid":false,"given":"Hugo C.","family":"Temperley","sequence":"additional","affiliation":[{"name":"Department of Radiology, St James Hospital, James\u2019s St, Saint James, Dublin 8, D08 NHY1 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"McGorrian","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, D07 WXC8 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u20132019: Update From the GBD 2019 Study","volume":"76","author":"Roth","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1001\/jama.291.2.210","article-title":"Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals","volume":"291","author":"Greenland","year":"2004","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1001\/jamacardio.2017.4973","article-title":"Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: A secondary analysis of the PROMISE randomised clinical trial","volume":"3","author":"Ferencik","year":"2018","journal-title":"JAMA Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_6","first-page":"e368","article-title":"2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain","volume":"144","author":"Gulati","year":"2021","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e14303","DOI":"10.1111\/eci.14303","article-title":"Percutaneous coronary revascularization versus medical therapy in chronic coronary syndromes: An updated meta-analysis of randomized controlled trials","volume":"54","author":"Panuccio","year":"2024","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1161\/CIRCULATIONAHA.119.044720","article-title":"Low-attenuation noncalcified plaque on coronary computed tomography angiography predicts myocardial infarction: Results from the SCOT-HEART trial","volume":"141","author":"Williams","year":"2020","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jcct.2014.07.003","article-title":"SCCT guidelines for the interpretation and reporting of coronary CT angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee","volume":"8","author":"Leipsic","year":"2014","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jcct.2016.11.003","article-title":"2016 SCCT\/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology","volume":"11","author":"Hecht","year":"2017","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/j.jacc.2008.07.031","article-title":"Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis","volume":"52","author":"Budoff","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e001695","DOI":"10.1136\/openhrt-2021-001695","article-title":"Incidentally identified coronary artery calcium on non-contrast CT scan of the chest predicts major adverse cardiac events among hospital inpatients","volume":"8","author":"Yu","year":"2021","journal-title":"Open Heart"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1161\/CIRCULATIONAHA.122.062746","article-title":"Incidental Coronary Artery Calcium: Opportunistic Screening of Previous Nongated Chest Computed Tomography Scans to Improve Statin Rates (NOTIFY-1 Project)","volume":"147","author":"Sandhu","year":"2023","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4723","DOI":"10.1007\/s00330-023-09428-z","article-title":"Incidental coronary artery calcification on non-gated CT thorax correlates with risk of cardiovascular events and death","volume":"33","author":"Wetscherek","year":"2023","journal-title":"Eur Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"923","DOI":"10.2214\/AJR.07.2974","article-title":"Coronary arterial calcification on low-dose ungated MDCT for lung cancer screening: Concordance study with dedicated cardiac CT","volume":"190","author":"Wu","year":"2008","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_17","first-page":"4459","article-title":"Prevalence and clinical implications of coronary artery calcium scoring on non-gated thoracic computed tomography: A systematic review and meta-analysis","volume":"34","author":"Ali","year":"2024","journal-title":"Eur. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1002\/clc.22685","article-title":"Coronary artery calcification is common on nongated chest computed tomography imaging","volume":"40","author":"Balakrishnan","year":"2017","journal-title":"Clin. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1148\/radiol.15142062","article-title":"Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: A Comparison of Three Scoring Methods","volume":"276","author":"Chiles","year":"2015","journal-title":"Radiology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2021). 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes\u20142021. Diabetes Care, 44, S15\u2013S33.","DOI":"10.2337\/dc21-S002"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"ehaa946.0172","DOI":"10.1093\/ehjci\/ehaa946.0172","article-title":"The utility of coronary artery calcium in non-gated high resolution CT thorax scans in predicting cardiac events as compared to the Framingham risk score: A retrospective study","volume":"41","author":"Saluja","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/j.jacc.2023.06.040","article-title":"Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging with Cardiovascular Outcomes","volume":"82","author":"Peng","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jcct.2018.10.019","article-title":"Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography","volume":"12","author":"Truong","year":"2018","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1161\/CIR.0000000000000351","article-title":"Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association","volume":"133","author":"Mehta","year":"2016","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"SCOT-HEART Investigators (2015). CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): An open-label, parallel-group, multicentre trial. Lancet, 385, 2383\u20132391.","DOI":"10.1016\/S0140-6736(15)60291-4"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"344","DOI":"10.2214\/AJR.19.22298","article-title":"Incidental Coronary Artery Calcification and Stroke Risk in Patients with Atrial Fibrillation","volume":"215","author":"Hillerson","year":"2020","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2413","DOI":"10.1016\/j.jacc.2019.02.060","article-title":"Prognostic implications of plaque characteristics and stenosis severity in patients with coronary artery disease","volume":"73","author":"Lee","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1056\/NEJMoa1805971","article-title":"Coronary CT angiography and 5-year risk of myocardial infarction","volume":"379","author":"Newby","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S422","DOI":"10.1016\/j.hlc.2024.06.147","article-title":"A missed opportunity: Incidental coronary artery calcification prior to acute coronary syndrome","volume":"33","author":"Hariharan","year":"2024","journal-title":"Heart Lung Circ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1148\/radiol.2283021006","article-title":"Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality","volume":"228","author":"Shaw","year":"2003","journal-title":"Radiology"},{"key":"ref_32","first-page":"j2099","article-title":"Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: Prospective cohort study","volume":"357","author":"Coupland","year":"2017","journal-title":"BMJ"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.jcmg.2015.06.030","article-title":"Relationship of Coronary Calcium on Standard Chest CT Scans with Mortality","volume":"9","author":"Dominguez","year":"2016","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1136\/thoraxjnl-2014-206160","article-title":"Incidental findings on chest CT imaging are associated with increased COPD exacerbations and mortality","volume":"70","author":"Jairam","year":"2015","journal-title":"Thorax"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s10554-016-0986-x","article-title":"National trends among radiologists in reporting coronary artery calcium in non-gated chest computed tomography","volume":"33","author":"Kirsch","year":"2017","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1016\/j.jacc.2022.08.805","article-title":"Coronary Calcium Scoring Improves Risk Prediction in Patients with Suspected Obstructive Coronary Artery Disease","volume":"80","author":"Winther","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e610","DOI":"10.1016\/j.jacl.2024.04.129","article-title":"Overcoming barriers to implementation: Improving incidental coronary calcium reporting on non-EKG gated chest CT scans","volume":"18","author":"Huey","year":"2024","journal-title":"J. Clin. Lipidol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Panuccio, G., Werner, G.S., De Rosa, S., Torella, D., Ichibori, Y., Carabetta, N., Skurk, C., Siegrist, P.T., Leistner, D.M., and G\u00f6ktekin, \u00d6. (Cardiovasc. Interv. Ther., 2025). Impact of coronary calcium patterns on procedural outcomes in CTO-PCI: A computed tomography-based multicenter study, Cardiovasc. Interv. Ther., online ahead of print.","DOI":"10.1007\/s12928-025-01200-y"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"131572","DOI":"10.1016\/j.ijcard.2023.131572","article-title":"Commissural alignment during TAVR reduces the risk of overlap to coronary ostia","volume":"395","author":"Carabetta","year":"2024","journal-title":"Int. J. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.jcct.2011.06.001","article-title":"SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT","volume":"5","author":"Halliburton","year":"2011","journal-title":"J. Cardiovasc. Comput Tomogr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"20200894","DOI":"10.1259\/bjr.20200894","article-title":"Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI\/BSCCT\/BSCMR","volume":"94","author":"Williams","year":"2021","journal-title":"Br. J. Radiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/12\/480\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T16:29:00Z","timestamp":1764865740000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/12\/480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,4]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcdd12120480"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12120480","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,4]]}}}