Abstract
This review aimed to assess thoracic aorta calcification (TAC) as a predictor of all-cause mortality, cardiovascular (CV) morbidity and mortality across various clinical settings using different imaging modalities. Medical databases were systematically searched up to mid-July 2025 for studies linking TAC with mortality and CV outcomes. A total of 43 studies involving 176,738 participants were included. TAC was associated with higher risks of all-cause mortality (hazard ratio [HR] = 1.614), CV mortality (HR = 2.130), coronary events (HR = 1.423), major adverse cardiac events (HR = 2.011) and stroke (HR = 1.450. Computed tomography showed the strongest associations (all-cause mortality HR = 1.810; CV mortality HR = 2.641), followed by chest radiography and echocardiography. Mortality risk was elevated across all aortic segments, including descending aorta (HR = 1.414), aortic arch (HR = 1.362), ascending aorta (HR = 1.350) and aortic root (HR = 1.240). TAC is a strong predictor of all-cause mortality, coronary events, CV mortality and morbidity.