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Updated: Jun 28, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Thoracic versus coronary calcification for atherosclerotic cardiovascular disease events prediction
Keishi Ichikawa1, Rui Wang2, Robyn L McClelland2
1The Lundquist Institute, Torrance, California, USA keishi.ichikawa@lundquist.org.
Insights
Thoracic artery calcium (TAC) on chest CT and coronary artery calcium (CAC) on cardiac CT both predict atherosclerotic cardiovascular disease (ASCVD) events. However, CAC scores offer superior prognostic value for ASCVD risk prediction.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Preventive Cardiology
Background:
- Thoracic artery calcium (TAC) on chest CT and coronary artery calcium (CAC) on ECG-gated cardiac CT are markers for cardiovascular risk.
- The prognostic value of TAC, including the aortic arch, compared to CAC for atherosclerotic cardiovascular disease (ASCVD) events requires further investigation.
Purpose of the Study:
- To compare the prognostic value of quantified thoracic artery calcium (TAC) on chest CT with coronary artery calcium (CAC) scores on ECG-gated cardiac CT for predicting incident ASCVD events.
Main Methods:
- Utilized data from 2412 participants in the Multi-Ethnic Study of Atherosclerosis Exam 5 who had both chest CT and ECG-gated cardiac CT.
- Measured TAC using the Agatston method on chest CT and CAC scores on cardiac CT.
- Compared prognostic value using time-dependent receiver-operating characteristic (ROC) curves and multivariable Cox regression analysis over a median follow-up of 8.8 years.
Main Results:
- A significant correlation (0.46, p<0.001) was observed between TAC and CAC scores.
- Both TAC (HR 1.31) and CAC (HR 1.82) were independently associated with ASCVD events.
- CAC scores demonstrated a significantly greater area under the time-dependent ROC curve (0.698 vs 0.641, p=0.031) compared to TAC, especially in individuals with intermediate to high ASCVD risk.
Conclusions:
- While TAC on chest CT shows a significant association with ASCVD events and provides supplementary risk data, it does not replace CAC scoring on ECG-gated cardiac CT.
- CAC scores possess superior prognostic value for predicting ASCVD events compared to TAC.
- These findings highlight the distinct yet complementary roles of TAC and CAC in cardiovascular risk assessment.
Abstract:
This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT.
Methods:
A total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident atherosclerotic cardiovascular disease (ASCVD) events. TAC is defined as calcification in the ascending aorta, aortic arch and descending aorta on chest CT. The quantification of TAC was measured using the Agatston method. Time-dependent receiver-operating characteristic (ROC) curves were used to compare the prognostic value of TAC and CAC scores.
Results:
Participants were 69±9 years of age and 47% were male. The Spearman correlation between TAC and CAC scores was 0.46 (p<0.001). During the median follow-up period of 8.8 years, 234 participants (9.7%) experienced ASCVD events. In multivariable Cox regression analysis, TAC score was independently associated with increased risk of ASCVD events (HR 1.31, 95% CI 1.09 to 1.58) as well as CAC score (HR 1.82, 95% CI 1.53 to 2.17). However, the area under the time-dependent ROC curve for CAC score was greater than that for TAC score in all participants (0.698 and 0.641, p=0.031). This was particularly pronounced in participants with borderline/intermediate and high 10-year ASCVD risk scores.
Conclusion:
Our study demonstrated a significant association between TAC and CAC scores but a superior prognostic value of CAC score for ASCVD events. These findings suggest TAC on chest CT provides supplementary data to estimate ASCVD risk but does not replace CAC on ECG-gated cardiac CT.
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