Aortic Arch Calcification Associated with Cardiovascular Events and Death among Patients with Acute Coronary Syndrome

Abstract

Background: To date, it remains unsettled whether aortic arch calcification (AAC) has prognostic value in patients with acute coronary syndrome.

Methods: From January 1 to December 31, 2013, a total of 225 patients with acute coronary syndrome (mean age 72 ± 26 years, 75% male) were enrolled in this study. Patients admitted to the coronary care unit of a tertiary referral medical center under the preliminary diagnosis of acute coronary syndrome were retrospectively investigated. The primary endpoint was composite of long-term major adverse cardiovascular events. The secondary endpoints were 30-day and long-term all-cause mortality.

Results: Of the 225 patients enrolled in this study, 143 had detectable AAC. Those who had AAC were older, with higher Killip classification and thrombolysis in myocardial infarction (TIMI) score with a lower probability of single vessel disease. Acute coronary syndrome patients with AAC had significantly higher 30-day mortality (17.3% vs. 7.1%, log-rank p = 0.02). During a mean follow-up period of 165 ± 140 days (maximum 492 days), the calcification group had significantly increased cardiovascular deaths (27.6% vs. 11.2%, log-rank p = 0.002), all-cause mortality (28.3% vs. 11.2%, log-rank p = 0.001) and composite endpoint of major adverse cardiovascular events (39.4% vs. 24.6%, log-rank p = 0.01). After adjusting for age, gender, diabetes mellitus and hypertension, AAC was an independent risk factor for primary and secondary endpoints among patients with acute coronary syndrome.

Conclusions: AAC provided valuable prognostic information on clinical outcomes in patients with acute coronary syndrome. However, different treatment strategies would be warranted for optimal risk reduction in such a population.

Keywords: Acute coronary syndrome; Aortic arch; Critical care; Thoracic radiography; Vascular calcification.

Figure 1

Grades of aortic arch calcification (AAC). Chest x-ray illustration of AAC (A) grade 0, (B) grade 1, (C) grade 2, and (D) grade 3.

Figure 2

Outcomes analysis according to presence of AAC. Kaplan-Meier analysis of (A) 30-day mortality, (B) cardiovascular mortality, (C) overall survival, and (D) major adverse cardiovascular events (MACE) between those with and without AAC.

Figure 3

Subgroup analysis of major adverse cardiovascular events between groups. Square dot: AAC negative group (reference group). Circle dot: AAC positive group. CI, confidence interval; DM, diabetes mellitus; HTN, hypertension; RHR, relative hazard ratio to reference group.

Figure 4

Outcomes analysis according to AAC grade. Survival and MACE rate for each grade of AAC. * p < 0.05.