Evaluating Coronary Arteries and Predicting MACEs Using CCTA in Lung Cancer Patients Receiving Chemotherapy or Chemoradiotherapy

Background Whether coronary computed-tomography angiography (CCTA) can detect cancer treatment-related impairments of coronary artery and predict major adverse cardiovascular events (MACEs) in lung cancer patients receiving chemotherapy (CHT) or chemoradiotherapy (CRT) is unclear. Objectives This study aimed to evaluate coronary arteries using CCTA parameters and explore the association of these parameters with MACEs in patients with lung cancer receiving CHT or CRT. Materials and methods This study retrospectively collected data from 697 lung cancer patients who received CHT or CRT and underwent CCTA examination within 2 weeks before or after treatment from June 2013 to May 2019. The patients were divided into CHT and CRT group, and for the control group, the propensity score matching (PSM) was used and 125 participants without carcinoma with a single CCTA examination were included. CCTA parameters, assessed using artificial intelligence software, were compared across different groups (control vs. CHT & CRT; CHT vs. CRT). We analyzed associations between CCTA parameters and MACEs using a Cox-regression model and Kaplan–Meier curves to compare MACE-free survival rates. Results Before CHT or CRT, compared with the control group, in CHT&CRT group we observed higher fat attenuation index (FAI), coronary-artery calcium (CAC) score, CAD-RADS classification, stenosis severity and lower computed-tomography fractional flow reserve (CT-FFR; all P<0.05). After treatment, the CT-FFR decreased and the FAI increased; simultaneously, we observed a lower CT-FFR and higher FAI (all P<0.05) in the CRT than in the CHT group. Among the 146 cases developed MACEs, lower CT-FFR and higher FAI values were found compared with the non-MACE group (all P<0.05), and CT-FFR and FAI before treatment were associated with MACEs. Conclusion Cancer treatment-related impairments of coronary arteries could be identified using CT-FFR and FAI. Before treatment, these parameters were associated with MACEs in lung cancer patients receiving CHT or CRT.