Abstract
Background Incidental findings of coronary artery calcifications (CACs) are not consistently reported, and the clinical significance relating to cardiovascular outcomes remains to be established. In this single-center cross-sectional study, we assessed the association between incidental coronary artery calcification documented on formal chest CT reports and the incidence of major adverse cardiovascular events (MACE). Methods A MACE was defined as the occurrence of stroke or transient ischemic attack or ST-segment elevation myocardial infarction, non-ST-elevation myocardial infarction, or undergoing coronary artery bypass grafting. A composite endpoint included either MACE or the occurrence of cardiovascular death. We assessed the predictors of the composite outcome and the effect of lipid-lowering therapy on the composite outcome in the studied cohort. Results The composite outcome occurred in 39.1% of the 1,354 subjects studied. Peripheral arterial disease was the only comorbid condition associated with increased odds (adjusted odds ratio (aOR) 2.6, p < 0.001, 95% CI: 1.9 - 3.56). The average treatment effect of lipid-lowering therapy was 0.11 (p = 0.002, 95% CI: 0.04 - 0.17). At 10 years after the first CAC report, the presence of peripheral artery disease appears to present the lowest odds of survival, which is <50% (hazard ratio (HR) 2.44, p < 0.001, 95% CI: 1.67 - 3.56). Conclusion In patients with CAC on incidental chest CT scans, the presence of peripheral arterial disease is associated with increased odds of MACE and/or cardiovascular death. In those with incidental CAC on non-gated chest CT scans, the residual risk for MACE remains high despite lipid-lowering therapy and antiplatelet agents.