Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina.
BACKGROUND
The coronary artery calcium (CAC) and aortic arch calcification (AoAC) are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina.


METHODS
A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3.


RESULTS
During the four years of follow-up, 620 patients were treated by coronary stenting and 153 (7%) adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score < 400, AoAC showed an additive predictive value in detecting significant coronary artery disease (CAD). A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score.


CONCLUSIONS
As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.
Cardiovascular Division, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
Jong Shin
JS
Woo
Cardiovascular Division, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
Weon
W
Kim
Department of Radiology, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
Se Hwan
SH
Kwon
Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
Hyo Chul
HC
Youn
Cardiovascular Division, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
Hyun Soo
HS
Kim
Cardiovascular Division, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
Jin Bae
JB
Kim
Cardiovascular Division, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
Soo Joong
SJ
Kim
Cardiovascular Division, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
Woo-Shik
WS
Kim
Cardiovascular Division, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea.
Kwon Sam
KS
Kim
Aortic arch; Atherosclerosis; Calcification; Coronary artery disease