Visually scored calcifications in thoracic arteries predict death: follow-up study after lung cancer CT screening

Coronary arterial calcification scoring with special cardiac algorithms predicts death. However, a large number of patients undergo a non-cardiac chest CT for other reasons and the information on such arterial calcifications has so far received little attention.

To explore whether visually detected chest atherosclerotic calcifications, which are unrelated to the indication of chest CT, predict mortality.

A total of 504 men (aged 39-81 years, mean 63 years) were previously screened for lung cancer with spiral CT and later visually scored for atherosclerotic calcifications in the aorta and the origin of its great branches, and in coronary arteries. Their mortality was later checked in the national register, at a mean follow-up time of 10.4 years. Cox regression was used, adjusted for age, BMI, smoked pack-years, and asbestos exposure.

One hundred and sixty deaths occurred during the follow-up, of which 57 were from cardiovascular disease. Calcifications at several sites significantly predicted all-cause and cardiovascular deaths in the enter models. In the backward model, calcifications in the aortic arch (hazard ratio HR = 1.35, 95% confidence interval 1.08-1.69, P = 0.009) and in the brachiocephalic origin (HR = 1.45, 1.15-1.82, P = 0.002) remained independent predictors of all-cause deaths. As regards cardiovascular deaths, calcifications in the left anterior descending artery (HR = 1.86, 1.29-2.67, P = 0.001) and brachiocephalic calcifications (HR = 1.65, 1.09-2.49, P = 0.018) remained independent predictors in the backward models.

Incidental arterial calcifications in routine chest CT should be actively reported to aid the recognition, preventive measures and medication of early atherosclerosis. The value of interventions after finding such calcifications should be further studied.