Aortic Arch Calcification in Predicting Timi and Killip Scores Based on Chest X Ray Examination in Patients With St-Elevation Myocardial Infarction (Stemi) at Adam Malik Hospital
Main Article Content
This study aim to analyze the AAC predicts TIMI and Killip scores based on chest X-ray examinations in patients with STEMI. This study is an observational analytical research with a diagnostic test design on 100 STEMI patients who had chest X-rays at Adam Malik Hospital and were evaluated for aortic arch calcification (AAC) scores semi-quantitatively. Analyzing the prediction of TIMI and Killip scores based on aortic arch calcification. Based on the analysis results, AAC in predicting TIMI score has a sensitivity of 48.6% and a specificity of 72.3% (AUC: 0.644). The Killip score has a sensitivity of 37.1% and a specificity of 78.5% (AUC: 0.562). The Positive Predictive Values of TIMI and Killip, respectively, are 64.6% and 64.2% and Negative Predictive Values are 57.5% and 54.5%. AAC is inadequate in predicting TIMI and Killip scores for patients with STEMI.
Keywords:
ST-Elevation Myocardial Infarction (STEMI), Aortic Arch Calcification, TIMI, Killip, Coronary Artery Disease
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Tian, W. B., Zhang, W. Sen, Jiang, C. Q., Liu, X. Y., Jin, Y. L., Lam, T. H., Cheng, K. K., & Xu, L. (2022). Aortic arch calcification and risk of all-cause mortality and cardiovascular disease: the Guangzhou Biobank Cohort Study. The Lancet Regional Health–Western Pacific, 23.
Vaduganathan, M., Mensah, G. A., Turco, J. V., Fuster, V., & Roth, G. A. (2022). The global burden of cardiovascular diseases and risk: a compass for future health. In Journal of the American College of Cardiology (Vol. 80, Issue 25, pp. 2361–2371). American College of Cardiology Foundation Washington DC.
van der Toorn, J. E., Bos, D., Arshi, B., Leening, M. J. G., Vernooij, M. W., Ikram, M. A., Ikram, M. K., & Kavousi, M. (2021). Arterial calcification at different sites and prediction of atherosclerotic cardiovascular disease among women and men. Atherosclerosis, 337, 27–34.
Watanabe, K., Hada, Y., Ishii, K., Nagaoka, K., Takase, K., Kameda, W., Susa, S., Saigusa, T., Egashira, F., & Ishihara, H. (2022). Aortic arch calcification with pericardial fat mass detected on a single chest X-ray image is closely associated with the predictive variables of future cardiovascular disease. Heart and Vessels, 37(4), 654–664.
Winiger, A., & Rodgers, G. P. (2023). Acute Coronary Syndrome (ACS) ST Segment Elevation Myocardial Infarction. In Cardiovascular Manual for the Advanced Practice Provider: Mastering the Basics (pp. 21–30). Springer.
Wi?niewski, P., Rostoff, P., Gajos, G., Nessler, J., & Kruszelnicka, O. (2019). Predictive value of electrocardiographic ST?segment elevation myocardial infarction equivalents for detecting acute coronary artery occlusion in patients with non–ST?segment elevation myocardial infarction. Polish Heart Journal (Kardiologia Polska), 77(6), 624–631.
World Health Organization. (2023). Cardiovascular diseases. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases
Yamaguchi, Y., Tanaka, T., Yoshimura, S., Koga, M., Nagatsuka, K., & Toyoda, K. (2017). A novel evaluation for predicting aortic complicated lesions using calcification on chest X-ray. Cerebrovascular Diseases, 44(3–4), 169–178.
Yang, C.-J., Tsai, S.-H., Wang, J.-C., Chang, W.-C., Lin, C.-Y., Tang, Z.-C., & Hsu, H.-H. (2019). Association between acute aortic dissection and the distribution of aortic calcification. PloS One, 14(7), e0219461.
Del Buono, M. G., Montone, R. A., Rinaldi, R., Gurgoglione, F. L., Meucci, M. C., Camilli, M., Iannaccone, G., Sanna, T., Pedicino, D., & Trani, C. (2021). Clinical predictors and prognostic role of high Killip class in patients with a first episode of anterior ST-segment elevation acute myocardial infarction. Journal of Cardiovascular Medicine, 22(7), 530–538.
Ghoshhajra, B. B., Hedgire, S. S., Koweek, L. M. H., Beache, G. M., Brown, R. K. J., Davis, A. M., Hsu, J. Y., Johnson, T. V, Kicska, G. A., & Kligerman, S. J. (2021). ACR appropriateness Criteria® asymptomatic patient at risk for coronary artery disease: 2021 update. Journal of the American College of Radiology, 18(5), S2–S12.
Harmadha, W. S. P., Muharram, F. R., Gaspar, R. S., Azimuth, Z., Sulistya, H. A., Firmansyah, F., Multazam, C. E. C. Z., Harits, M., & Putra, R. M. (2023). Explaining the increase of incidence and mortality from cardiovascular disease in Indonesia: A global burden of disease study analysis (2000–2019). PLoS One, 18(12), e0294128.
Huang, A., Qi, X., Cui, Y., Wu, Y., Zhou, S., & Zhang, M. (2020). Serum VEGF: diagnostic value of acute coronary syndrome from stable angina pectoris and prognostic value of coronary artery disease. Cardiology Research and Practice, 2020(1), 6786302.
Kimani, C., Kadota, A., Miura, K., Fujiyoshi, A., Zaid, M., Kadowaki, S., Hisamatsu, T., Arima, H., Horie, M., & Ueshima, H. (2019). Differences between coronary artery calcification and aortic artery calcification in relation to cardiovascular disease risk factors in Japanese men. Journal of Atherosclerosis and Thrombosis, 26(5), 452–464.
Kimura, S., Sugiyama, T., Hishikari, K., Nakagama, S., Nakamura, S., Misawa, T., Mizusawa, M., Hayasaka, K., Yamakami, Y., & Sagawa, Y. (2018). The clinical significance of echo-attenuated plaque in stable angina pectoris compared with acute coronary syndromes: a combined intravascular ultrasound and optical coherence tomography study. International Journal of Cardiology, 270, 1–6.
Ma, X., Hou, F., Tian, J., Zhou, Z., Ma, Y., Cheng, Y., Du, Y., Shen, H., Hu, B., & Wang, Z. (2019). Aortic arch calcification is a strong predictor of the severity of coronary artery disease in patients with acute coronary syndrome. BioMed Research International, 2019(1), 7659239.
Mihajlovi?, D., Maksimovi?, Ž. M., Doj?inovi?, B., & Banjac, N. (2020). Acute coronary syndrome (STEMI, NSTEMI and unstable angina pectoris) and risk factors, similarities and differences. Scripta Medica, 51(4), 252–260.
M?ynarska, E., Czarnik, W., Fularski, P., Hajdys, J., Majchrowicz, G., Stabrawa, M., Rysz, J., & Franczyk, B. (2024). From atherosclerotic plaque to myocardial infarction—The leading cause of coronary artery occlusion. International Journal of Molecular Sciences, 25(13), 7295.
Naveed, A., Atique, R., Saeed, H. A., Sharif, J., Haidar, A., & Samad, A. (2024). Cardiovascular Diseases: Understanding the Leading Cause of Death Worldwide. Global Journal of Multidisciplinary Sciences and Arts, 1(1), 100–110.
Non-Communicable Disease (NCD) Indonesian Surveillance Information System. (2016). Cardiovascular Disease (CVD) diagnosis statistics.
Polat, F., Tüner, H., Çakmak, Ç. B., & Özbek, E. (2025). Impact of cardiac rehabilitation on adherence to secondary prevention measures across STEMI, NSTEMI, and unstable angina pectoris subgroups: a randomized controlled trial in high-risk patients. Acta Cardiologica, 80(10), 1081–1101.
Popovic, B., Agrinier, N., Bouchahda, N., Pinelli, S., Maigrat, C. H., Metzdorf, P. A., Selton Suty, C., Juillière, Y., & Camenzind, E. (2018). Coronary embolism among ST-segment–elevation myocardial infarction patients: mechanisms and management. Circulation: Cardiovascular Interventions, 11(1), e005587.
Qureshi, W. T., Kakouros, N., Fahed, J., & Rade, J. J. (2021). Comparison of prevalence, presentation, and prognosis of acute coronary syndromes in? 35 years, 36–54 years, and? 55 years patients. The American Journal of Cardiology, 140, 1–6.
Sujarwoto, S., Maharani, A., Praveen, D., Palagyi, A., Kumar, P. S. G., Abimbola, S., Tampubolon, G., & Patel, A. (2025). Healthcare access and socio-demographic determinants of estimated 10-year risk of cardiovascular diseases in Indonesia: A population-based study. Plos One, 20(8), e0318112.
Tian, W. B., Zhang, W. Sen, Jiang, C. Q., Liu, X. Y., Jin, Y. L., Lam, T. H., Cheng, K. K., & Xu, L. (2022). Aortic arch calcification and risk of all-cause mortality and cardiovascular disease: the Guangzhou Biobank Cohort Study. The Lancet Regional Health–Western Pacific, 23.
Vaduganathan, M., Mensah, G. A., Turco, J. V., Fuster, V., & Roth, G. A. (2022). The global burden of cardiovascular diseases and risk: a compass for future health. In Journal of the American College of Cardiology (Vol. 80, Issue 25, pp. 2361–2371). American College of Cardiology Foundation Washington DC.
van der Toorn, J. E., Bos, D., Arshi, B., Leening, M. J. G., Vernooij, M. W., Ikram, M. A., Ikram, M. K., & Kavousi, M. (2021). Arterial calcification at different sites and prediction of atherosclerotic cardiovascular disease among women and men. Atherosclerosis, 337, 27–34.
Watanabe, K., Hada, Y., Ishii, K., Nagaoka, K., Takase, K., Kameda, W., Susa, S., Saigusa, T., Egashira, F., & Ishihara, H. (2022). Aortic arch calcification with pericardial fat mass detected on a single chest X-ray image is closely associated with the predictive variables of future cardiovascular disease. Heart and Vessels, 37(4), 654–664.
Winiger, A., & Rodgers, G. P. (2023). Acute Coronary Syndrome (ACS) ST Segment Elevation Myocardial Infarction. In Cardiovascular Manual for the Advanced Practice Provider: Mastering the Basics (pp. 21–30). Springer.
Wi?niewski, P., Rostoff, P., Gajos, G., Nessler, J., & Kruszelnicka, O. (2019). Predictive value of electrocardiographic ST?segment elevation myocardial infarction equivalents for detecting acute coronary artery occlusion in patients with non–ST?segment elevation myocardial infarction. Polish Heart Journal (Kardiologia Polska), 77(6), 624–631.
World Health Organization. (2023). Cardiovascular diseases. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases
Yamaguchi, Y., Tanaka, T., Yoshimura, S., Koga, M., Nagatsuka, K., & Toyoda, K. (2017). A novel evaluation for predicting aortic complicated lesions using calcification on chest X-ray. Cerebrovascular Diseases, 44(3–4), 169–178.
Yang, C.-J., Tsai, S.-H., Wang, J.-C., Chang, W.-C., Lin, C.-Y., Tang, Z.-C., & Hsu, H.-H. (2019). Association between acute aortic dissection and the distribution of aortic calcification. PloS One, 14(7), e0219461.
