Predictive value of coronary artery calcium score on radiological and autoptic findings in cases of sudden death

Calcium Artery Coronary Score (CACS) is a noninvasive examination of the coronary arteries in which the amount of calcium is calculated using cardiac Computed Tomography. The role of postmortem imaging in sudden death has been the subject of increasing interest in recent years, and previous studies have proposed a possible correlation between CACS and autopsy findings. The present study aims to establish a correlation between CACS, the presence of coronary artery opacification defects on Multi-Phase Post-Mortem Computed Tomography Angiography (MPMCTA), and the presence of coronary stenosis at autopsy, in order to verify whether CACS confirms its predictive value in terms of cardiac risk and can guide the decision to perform or not to perform MPMCTA. A cohort of 24 subjects who died suddenly was examined. Firstly, MPMCTA was performed, then autopsy was carried out. CACS was calculated, the detection of opacification defects on MPMCTA was investigated and the presence of coronary stenoses on autopsy was described. 24 deceased individuals (53 years +/- 11.7; 20 men) were evaluated. CACS has a positive predictive value of 0.78 and a negative predictive value of 0.73 in assessing the presence of radiological coronary artery opacification defects. The positive predictive value on stenosis relief is 0.88, while the negative predictive value on the same relief is 0.73. CACS is an appropriate additional tool in the evaluation of sudden death cases. Our results provided an encouraging contribution to the systematic application of CACS in cases of sudden death.