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.
Does the presence of incidental cardiovascular calcifications on screening low-dose chest CT predict long-term all-cause mortality and major adverse cardiovascular events?
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.
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.
Lee et al. (2026) studied this question. 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.