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Original research article
Agatston score of the descending aorta is independently associated with coronary events in a low-risk population
  1. Elton A M P Dudink1,
  2. Frederique E C M Peeters1,
  3. Sibel Altintas1,
  4. Luuk I B Heckman1,
  5. Rutger J Haest2,
  6. Hans Kragten3,
  7. Bas L J H Kietselaer1,4,
  8. Joachim Wildberger4,
  9. Justin G L M Luermans1,
  10. Bob Weijs1 and
  11. Harry J G M Crijns1
  1. 1 Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
  2. 2 Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands
  3. 3 Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
  4. 4 Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
  1. Correspondence to Dr Elton A M P Dudink; elton.dudink{at}


Objectives A standard coronary artery calcium scan includes part of the aorta. This additional information is often not included in routine analyses. We aimed to determine the feasibility of assessing the Agatston score of the descending aorta calcification (DAC) on standard coronary calcium scans and the association of this score with coronary events in a low-risk study population.

Methods Between January 2008 and March 2011, 390 consecutive patients who were referred for cardiac CT as part of work-up for pulmonary vein isolation (n=115) or assessment of presence of coronary artery disease (n=275) were included. At baseline, all patients were free of a history of cardiovascular disease. Two independent observers determined the Agatston score of the ascending aorta and descending aorta.

Results A total of 16 patients (4.1%) developed coronary events (acute coronary syndrome (n=6) and symptomatic significant coronary artery disease requiring treatment (n=10)) during a follow-up of 67±12 months, with more events in patients with calcifications in the descending aorta than in those without (8.4% vs 3.7 %; p=0.08). Multivariable Cox regression, corrected for Framingham Risk Score (FRS) and coronary Agatston score (CAC), revealed that DAC was independently associated with coronary events (per 100 units; HR: 1.06, 95% CI 1.02 to 1.09; p=0.001). DAC furthermore increased the identification of patients that will experience a coronary event (area under the curve: 0.68 for FRS only, 0.75 for FRS+CAC and 0.78 for FRS+CAC+DAC).

Conclusions The Agatston score of the descending aorta could be included in the standard analysis of cardiac CT scans of low-risk patients since it holds valuable information for the prediction of coronary events.

  • aorta
  • calcification
  • physiologic
  • tomography
  • X-ray computed
  • coronary artery disease
  • follow-up studies

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  • Contributors EAMPD, BLJHK, JGLML, BW and HJGMC contributed to the conception or design of the work. All authors contributed to the acquisition, analysis or interpretation of data for the work. EAMPD drafted the manuscript. HJGMC acquired funding. All authors critically revised and approved the manuscript.

  • Funding We acknowledge the support from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON 2014-9: Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodeling, and Vascular destabilization in the progression of AF (RACE V), and the European Union's Horizon 2020 Research and Innovation Program (CATCH ME - grant number 633196).

  • Competing interests One author (JW) of this manuscript declares institutional relationships with the following companies: Siemens AG, Bayer Healthcare, Philips, GE, all outside submitted work.

  • Patient consent for publication Not required.

  • Ethics approval IRB academic Hospital Maastricht/Maastricht University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The dataset used and analysed during the current study are available from the corresponding author on reasonable request.

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