Extent of aortic arch calcification on chest radiographs is associated with coronary artery disease severity

Objective: Visible aortic arch calcification (AAC) on chest radiographs is putatively associated with cardiovascular outcomes. This retrospective study investigated a correlation between the semi-quantitative extent of AAC and cardiovascular disease severity. Methods: 305 consecutive patients presenting with chest pain who underwent coronary artery angiography and chest radiography during the same hospital stay were retrospectively enrolled. Radiologists blinded to the results of the coronary angiography graded the extent of AAC on a 4-point scale, grades 0-3. The severity of coronary artery disease was described by the number of diseased vessels and Gensini score. Results: AAC was graded as 0, 1, 2, and 3 in 182, 43, 51, and 29 patients, respectively. With increasing AAC grade, the patients tended to be older and coronary artery disease was more prevalent. The AAC grade significantly correlated with the number of affected coronary arteries, and the average Gensini score (P < 0.001, both). AAC grade 3 was an independent predictor for multivessel disease (OR 1.720, 95% CI, 1.184-2.498, P = 0.004) and high Gensini score (OR 1.529, 95% CI, 1.153-2.029, P = 0.003). Conclusion: The extent of AAC, semi-quantitatively determined by chest radiograph, correlated with the severity of coronary artery disease (number of diseased vessels and Gensini score). The highest AAC grade was an independent predictor of multivessel disease and high Gensini score.