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Original research
Thoracic versus coronary calcification for atherosclerotic cardiovascular disease events prediction
  1. Keishi Ichikawa1,
  2. Rui Wang2,
  3. Robyn L McClelland2,
  4. Venkat S Manubolu1,
  5. Shriraj Susarla1,
  6. Duo Lee1,
  7. Leili Pourafkari1,
  8. Hooman Fazlalizadeh1,
  9. Jairo Aldana Bitar1,
  10. Rick Robin1,
  11. April Kinninger1,
  12. Sion Roy1,
  13. Wendy S Post3,
  14. Matthew Budoff1
  1. 1The Lundquist Institute, Torrance, California, USA
  2. 2Department of Biostatistics, University of Washington, Seattle, Washington, USA
  3. 3Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Keishi Ichikawa, Department of Cardiovascular Medicine, The Lundquist Institute, Torrance, CA 90502, USA; keishi.ichikawa{at}


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.

  • Computed Tomography Angiography
  • Atherosclerosis
  • Coronary Artery Disease

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Correction notice This article has been corrected since it was first published. The second author's first name and surname were mistakenly interchanged.

  • Contributors KI and MB are guarantors and accept responsibility for the overall content of the study. KI: conceptualisation, methodology and writing—original draft; RW: data curation, formal analysis; RLM: data curation, formal analysis; VSM: writing—review and editing; SS: data collection, writing—review and editing; DL: data collection, writing—review and editing; LP: writing—review and editing; HF: writing—review and editing; JAB: writing—review and editing; RR: data collection, writing—review and editing; AK: data curation, writing—review and editing; SR: writing—review and editing; WSP: writing—review and editing; MB: writing—conceptualisation, methodology, writing—review and editing, supervision.

  • Funding This research was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079 and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). The authors thank the other investigators, the staff and the participants of the MESA study for their valuable contributions. This publication was developed under the Science to Achieve Results (STAR) research assistance agreements, No RD831697 (MESA Air) and RD-83830001 (MESA Air Next Stage), awarded by the U.S. Environmental Protection Agency (EPA). It has not been formally reviewed by the EPA. The views expressed in this document are solely those of the authors and the EPA does not endorse any products or commercial services mentioned in this publication. A full list of participating MESA investigators and institutions can be found at online ( This paper has been reviewed and approved by the MESA Publications and Presentations Committee. KI is supported in parts by Takeda Science Foundation, Fukuda Foundation for Medical Technology, Wesco Scientific Promotion Foundation, Teraoka Memorial Foundation, Mochida Memorial Foundation for Medical and Pharmaceutical Research. MB has received National Institutes of Health grant and research support from General Electric Company.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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