Prognostic value of coronary artery calcification score for long-term risk of stroke, atrial fibrillation and mortality: Analysis of real-world data

Published Date: 23rd October 2026

Publication Authors: Elsheikh. S, Hill. AM

Background
Coronary artery calcification (CAC) score has been implicated in cardiovascular risk assessment, yet its role in predicting incident ischaemic stroke (IS), atrial fibrillation (AF), and all-cause mortality in the general population remains unclear. We aimed to evaluate the association between CAC score and these outcomes using real-world hospital and community data.

Methods
We included adults who underwent CAC scoring at our local hospital between May 2010 and May 2018. CAC scores were classified into CAC Data and Reporting System (CAC DRS) categories (0-3) based on Agatston scoring. Study outcomes included incident IS, new-onset AF, and all-cause mortality, with follow-up data obtained from medical record linkage. Kaplan-Meier survival analysis, restricted cubic spline models, and Cox proportional hazards models were employed to evaluate associations between CAC score and outcomes, adjusting for potential confounders. Sensitivity analyses were conducted to assess robustness.

Results
We included 2,175 patients (mean age: 51.47, SD 11.05 years, 62.7% female). During a mean follow-up of about 10 years, 42 (1.9%) patients had incident IS and 126 (5.8%) died, while 135 (6.4%) of 2122 patients developed new-onset AF. No significant association of CAC score and clinical outcomes was evident on Kaplan-Meier survival analysis or restricted cubic spline analysis. On multivariable analysis, CAC DRS category 2 was significantly associated with an increased risk of IS (HR = 2.82, 95%CI: 1.02–7.84, p = 0.047), while no significant associations were observed for AF or all-cause mortality. Sensitivity analysis confirmed the increased IS risk in CAC DRS 2 (HR = 2.89, 95%CI: 1.04–8.04, p = 0.042), but no significant associations for AF or all-cause mortality.

Conclusion
CAC is not independently associated with AF and all-cause mortality in the general population. Moderate CAC burden (CAC DRS 2) may be associated to increased IS risk, warranting further research on its role in cerebrovascular risk stratification.

Elsheikh, S; Hill, AM; Abdul-Rahim, AH et al. (2026). Prognostic value of coronary artery calcification score for long-term risk of stroke, atrial fibrillation and mortality: Analysis of real-world data. Current problems in cardiology. 52(1), Article 103482. [Online]. Available at: https://doi.org/10.1016/j.cpcardiol.2026.103482 [Accessed 30 October 2026]