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The following is a summary of “Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction,” published in the April 2025 issue of Annals of Intensive Care by Brunel et al. 

Researchers conducted a retrospective study to evaluate the visual coronary artery calcification (VCAC) score from chest computed tomography (CT) in predicting significant coronary artery stenosis, culprit lesions, or the need for ad hoc or delayed percutaneous coronary intervention (PCI) after cardiac arrest without ST-segment elevation myocardial infarction (STEMI).  

They assessed 113 individuals with cardiac arrest and without STEMI who underwent coronary angiography and chest CT (January 2013 to March 2023, Croix-Rousse Hospital, Lyon, France). The VCAC score ranged from 0 (no calcification) to 3 (diffuse calcification) for each of the 4 mhurain arteries (left main, left anterior descending, circumflex, and right coronary artery). At baseline, the median [interquartile range] age was 65.8 years [53.4–75.7], with 61.9% male and 59.3% presenting with ventricular fibrillation.  

The results showed that coronary angiography identified significant coronary artery stenosis in 32.7%, while ad hoc and delayed PCI was performed in 12.4% and 6.2%, respectively. The VCAC score was a strong predictor of significant coronary artery stenosis, with an area under the receiver operating characteristic curve (ROC) area under the ROC curve (AUC) of 0.95 (95% confidence interval [CI] [0.90–1.00]) and an optimal threshold of ≥4 (specificity 94.7%, sensitivity 91.9%). For detecting culprit coronary artery stenosis, the AUC was 0.90 (95% CI [0.85–0.96]), with an optimal threshold of ≥5 (specificity 83.5%, sensitivity 87.5%). The AUC for predicting ad hoc PCI was 0.886 (95% CI [0.823–0.948]; specificity 81.8%, sensitivity 85.7%), while for both delayed and ad hoc PCI, it was 0.921 (95% CI [0.872–0.972]; specificity 85.3%, sensitivity 88.9%), with an optimal threshold of VCAC ≥5. A VCAC score ≥4 achieved 100% sensitivity in predicting significant or culprit coronary artery stenosis and the need for ad hoc or delayed PCI.  

Investigators concluded that a non-dedicated CT thorax could be used to measure VCAC, and a score of ≥4 could help physicians identify resuscitated non-STEMI patients suffering cardiac arrest without prior coronary artery disease who might benefit from emergency coronary angiography and PCI if needed. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01423-5