What does this research mean for the field?

Incidental thoracic aortic calcification (TAC) ≥1000 increases all-cause mortality risk 3.11-fold, and coronary artery calcification (CAC) ≥400 increases MACE risk 8.67-fold, but combining multiple incidental calcifications adds no extra prognostic value beyond CAC alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 28, 2026

Incidental cardiovascular calcifications detected on screening CT: prognostic impact over long-term follow-up

Key Result

Incidental TAC ≥1000 increased all-cause mortality risk 3.11-fold, and CAC ≥400 increased MACE risk 8.67-fold; combined calcifications added no extra prognostic value.

Key Points

To assess the long-term prognostic significance of incidental cardiovascular calcifications detected on low-dose CT scans.
Retrospective cohort study involving individuals undergoing LDCT between 2007 and 2013.
Quantification of CAC, TAC, AVC, and MAC by a cardiovascular radiologist using dedicated software.
Associations with all-cause mortality and major adverse cardiovascular events were evaluated using multivariable Cox proportional hazards regression.
Incremental prognostic performance assessed using Harrell's concordance index.
CAC identified in 20.8%, TAC in 49.9%, AVC in 6.5%, and MAC in 2.0% of individuals.
TAC category ≥1000 was associated with increased risk of all-cause mortality (HR = 3.11).
CAC category ≥400 showed strong association with major adverse cardiovascular events (HR = 8.67).
Combined model of CAC, TAC, AVC, and MAC did not provide significant incremental prognostic value beyond CAC alone.

Structured PICO

Does the presence of incidental cardiovascular calcifications on screening low-dose chest CT predict long-term all-cause mortality and major adverse cardiovascular events?

Population

2,434 individuals who underwent screening non-gated, non-contrast low-dose chest computed tomography (LDCT) at a single health promotion center between 2007 and 2013 (median age 54.2 years, 1,863 men).

Intervention

Detection and quantification of incidental cardiovascular calcifications (coronary artery calcification [CAC], thoracic aortic calcification [TAC], aortic valve calcification [AVC], and mitral annular calcification [MAC]) on screening LDCT.

Comparator

Absence or lower categories of incidental cardiovascular calcifications.

Outcome

All-cause mortality (ACM) and major adverse cardiovascular events (MACE, defined as revascularization, myocardial infarction, stroke, or cardiovascular death).composite

Incidental coronary and thoracic aortic calcifications detected on screening low-dose chest CT are strong predictors of MACE and all-cause mortality, respectively, though combining multiple calcification sites does not improve prognostic accuracy over CAC alone.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background The prognostic significance of incidental cardiovascular calcifications—including coronary artery calcification (CAC), thoracic aortic calcification (TAC), aortic valve calcification (AVC), and mitral annular calcification (MAC)—detected on non-gated, non-contrast low-dose chest computed tomography (LDCT) remains unclear. Purpose To evaluate the long-term prognostic significance of incidental cardiovascular calcifications detected on screening LDCT. Material and Methods This retrospective cohort study included individuals who underwent LDCT at a single health promotion center between 2007 and 2013. A cardiovascular radiologist quantified CAC, TAC, AVC, and MAC using dedicated software. Multivariable Cox proportional hazards regression was used to assess associations with all-cause mortality (ACM) and major adverse cardiovascular events (MACE), defined as revascularization, myocardial infarction, stroke, or cardiovascular death. Incremental prognostic performance was evaluated using Harrell's concordance index (C-index). Results Among the 2434 included individuals (1863 men; median age = 54.2 years), CAC, TAC, AVC, and MAC were identified in 506 (20.8%), 1215 (49.9%), 159 (6.5%), and 49 (2.0%), respectively. The highest TAC category (≥1000) showed the strongest association with ACM (hazard ratio HR = 3.11, 95% confidence interval CI = 1.57–6.16; P = 0.001). The highest CAC category (≥400) showed the strongest association with MACE (HR = 8.67, 95% CI = 4.46–16.88; P <0.001). However, a combined model incorporating CAC, TAC, AVC, and MAC did not provide significant incremental prognostic value beyond CAC alone for ACM or MACE. Conclusion Incidental TAC was associated with increased long-term risk of ACM, while CAC was associated with MACE. However, their combined incorporation did not provide significant incremental prognostic value.

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