Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis

Sina Kianoush, Mahmoud Al Rifai, Miguel Cainzos-Achirica, Mouaz H. Al-Mallah, Geoffrey H. Tison, Joseph Yeboah, Michael D. Miedema, Matthew A. Allison, Nathan D. Wong, Andrew P. DeFilippis, William Longstreth, Khurram Nasir, Matthew J. Budoff, Kunihiro Matsushita, Michael J. Blaha

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background and aims Atherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC). Methods We followed a total of 6805 participants (mean age 62.1 ± 10.2 years, 47.2% male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0–4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC. Results With an increasing number of thoracic ECC sites, there was a significant (p < 0.05) multivariable adjusted step-wise increase in the risk for ischemic stroke (n = 184), total stroke (n = 235), and TIA (n = 85), but not hemorrhagic stroke (n = 32) and stroke mortality (n = 42). Thoracic ECC increased the c-statistic and net reclassification index beyond traditional risk factors and CAC, but the results were not significant (p > 0.10). Conclusions Although multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
StatePublished - Dec 2017


  • Cardiovascular disease
  • Coronary artery calcium
  • Extracoronary calcium
  • Prevention
  • Risk prediction
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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