Coronary Artery Disease Association with Arterial Calcifications on Hand Radiographs
Erin M. Taylor, MD; Qing Z. Ruan, MD; Mathew L. Iorio, MD
Harvard University, Boston, MA
Background: Arterial calcifications have been linked with an increased risk of coronary artery disease (CAD) and attendant comorbidities. However, few studies have evaluated if the frequency and impact of upper extremity calcifications remains similar to that demonstrated in the lower extremity or cardiac vessels. Our study examines if a correlation exists between CAD and the presence of arterial calcifications on routine hand radiographs.
Methods: A review of 100 consecutive patients who presented to a single institution hand clinic with ICD-9 and ICD-10 diagnosis codes of CAD were performed. All patients underwent CAD screening with cardiac stress testing or coronary angiography, which determined patients with CAD and patients without CAD. Patients with chronic kidney disease (CKD) or end-stage renal disease were excluded from primary analysis given the known confounder for arterial calcifications.
Results: The study patient population had a mean age of 69.3 years (r, 48-99), BMI of 29.4 (r, 19-46), and male gender of 48%. Ethnicity included Caucasian (76%), Black (15%), Hispanic (6%), and Asian (3%). Patients had comorbidities of hypertension (79%), hyperlipidemia (83%), diabetes (53%), smoking (59%), and stroke (6%). In those CAD patients with hand radiographs, 28.6% (12/42) had an incidence of arterial calcifications on hand radiographs, compared with 5.3% (1/19) in patients without CAD (p=0.07). Nineteen patients with CKD were excluded from primary analysis, 94.7% (18/19) of whom had calcifications on hand x-ray.
Conclusions: Our preliminary data suggest that patients with CAD have a higher incidence of hand arterial calcifications on X-ray. Arterial calcifications seen on hand radiographs in the hand surgery patient population may warrant referral for further CAD diagnostic testing; however, this data may be utilized by the hand-surgery clinician when routine radiographs demonstrate calcification as a potential impetus or signal for referral to their primary physician for cardiac screening.
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