Mariana Diaz-Zamudio MD, Presenter: Nothing to Disclose

Peter Jay Julien, Abstract Co-Author: Nothing to Disclose

Damini Dey PhD, Abstract Co-Author: Research support, Siemens AG

Heidi Gransar, Abstract Co-Author: Nothing to Disclose

Louise J. Thomson MBCHB, Abstract Co-Author: Nothing to Disclose

John D. Friedman MD, Abstract Co-Author: Nothing to Disclose

Sean Hayes MD, Abstract Co-Author: Nothing to Disclose

Daniel S. Berman MD, Abstract Co-Author: Research Grant, Lantheus Medical Imaging, Inc Research Grant, Astellas Group Research Grant, Siemens AG Speaker, Bristol-Myers Squibb Company Speaker, Covidien AG Speaker, Astellas Group Stockholder, Spectrum Dynamics Ltd Consultant, Bracco Group Consultant, FlouroPharma, Inc

To determine whether breast arterial calcification (BAC) on mammography are predictive for high risk coronary calcium score (CAC) and coronary artery disease (CAD) identified by coronary CTA.

Consecutive female patients age >45 undergoing coronary CTA and CAC scanning for clinical purposes and screening mammography within 24 months from CTA were identified. Mammography studies were reviewed by an experienced reader blinded to CT results. BAC was assessed using a semi-quantitative scale (none/mild/moderate/severe). CAC was categorized as 0, 1-99, 100-399, and ≥400 and CTA as 0, <50%, 50-69%, and ≥70% stenosis grade. All clinical and risk-factor data were collected prospectively.

In 204 patients included, median time between mammography and CTA was 7 months (range 0-24). Median age was 63.2 years (range 45-88). BAC was present in 43 (21%). The BAC group was older (69.6 vs 61.5, p<0.001). By CAC category, CAC 100-399 and ≥400 were more common in the BAC group (CAC 100-399: 23.2 vs 16.1%; CAC≥400: 21 vs 6.2%, p=0.01) and CAC 0 and CAC 1-99 were more common in the no BAC group (CAC 0: 47.2 vs 37.2%; CAC 1-99: 30.4 vs 18.6%, p=0.01). By multivariable analysis (including age, BMI, hypertension, diabetes mellitus, smoking history, family history) moderate/severe BAC predicted CAC≥400 (OR 4.2, p=0.03). By CTA category, 50-69% and ≥70% stenosis were more common in the BAC group (50-69%: 11.6 vs 3.2%; ≥70%: 20.9 vs 7.8%; p=0.008). CAD 0 and stenosis <50% were more common in the no BAC group (CAD 0: 47 vs 34.8%; <50%: 42 vs 32.5%; p=0.008). On multivariable analysis BAC was a predictor of 50-69% stenosis (OR 3.5, p=0.01). To assess age interaction, a sub-analysis of patients >65 (n=91) was performed. In this subgroup, age was not different between BAC and no BAC groups (73.6 vs 72.4, p=0.32); however, the presence of CAC≥400 (41.6 vs 14%, p=0.019) and ≥50% stenosis (39.4 vs 17.2%, p=0.019) remained higher in the group with moderate/severe BAC. Moderate/severe BAC persisted as a multivariable predictor of CAC≥400 (OR 8.7, p=0.007) and ≥50% stenosis (OR 4.7, p=0.012).

BAC predicts high coronary calcium scores and CAD in coronary CTA independently of age and risk factors. 

BAC identified in routinely performed mammographies could potentially be used to direct further testing to detect CAD in women.

Diaz-Zamudio, M, Julien, P, Dey, D, Gransar, H, Thomson, L, Friedman, J, Hayes, S, Berman, D, Relationship of Breast Arterial Calcification with Coronary Calcium Score and Coronary CT Angiography.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011892.html