Incidental coronary artery calcification and stroke risk in patients with atrial fibrillation

Dustin Hillerson, Thomas Wool, Gbolahan O. Ogunbayo, Vincent L. Sorrell, Steve W. Leung

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective: Atrial fibrillation (AF) is a major risk factor for stroke. The CHA2DS2- VASc score is used to risk stratify patients, and the score includes known coronary artery disease (CAD) as a variable. The aim of this study was to assess if the presence of incidental coronary artery calcification (CAC), without known CAD, is associated with stroke independent of CHA2DS2-VASc variables. Materials And Methods: A retrospective review of health records was performed for patients who had AF, a chest CT scan performed within 1 year, and a subsequent visit for stroke. Patients with CAD and other vascular disease, a mechanical valve, or who were older than 74 years old were excluded. Included patients were one-to-one matched by age and CHA2DS2-VASc risk factors to patients who had had similar follow-up but who did not have a stroke. Nongated CT images were reviewed for CAC. Univariate and Cox regression analyses were performed. Results: A total of 203 patients met the study criteria, and 203 matched patients without stroke were identified. Median age was 61 years old with stroke and 62 years old without stroke (p = 0.99). In both groups, 82 (39.0%) were women and the median CHA2DS2-VASc was 2 (interquartile range, 1-2). Anticoagulation medication was prescribed to 46 (22.7%) patients in the group who had had a stroke and 52 (25.6%) in the group without stroke (p = 0.49). On Cox regression analysis, CAC was associated with stroke (hazard ratio [HR], 1.47; 95% CI, 1.10-1.97; p < 0.01) and mortality (adjusted HR, 1.41; 95% CI, 1.02-1.95; p = 0.04). Conclusion: Patients with AF and incidental CAC depicted on chest CT have an increased risk of stroke and mortality beyond established risk factors.

Original languageEnglish
Pages (from-to)344-350
Number of pages7
JournalAmerican Journal of Roentgenology
Issue number2
StatePublished - Aug 2020

Bibliographical note

Funding Information:
Supported by the National Institutes of Health, National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2020 American Roentgen Ray Society.


  • Atrial fibrillation
  • CT
  • Coronary artery calcification
  • Risk assessment
  • Stroke

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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