Coronary artery calcium score as a predictor for incident stroke: Systematic review and meta-analysis

Kongkiat Chaikriangkrai, Hye Yeon Jhun, Ghanshyam Palamaner Subash Shantha, Aref Bin Abdulhak, Gardar Sigurdsson, Faisal Nabi, John J. Mahmarian, Su Min Chang

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background Coronary artery calcium score (CACS) is a well-established test for risk stratifying asymptomatic patients for overall cardiovascular or coronary events. However; the prognostic value for incident stroke remains controversial. The objective of this study was to investigate the predictive value of CACS obtained by non-contrast electrocardiogram-gated computed tomography for incident stroke. Methods We searched PubMed, EMBASE, Cochrane databases for prospective longitudinal studies of CACS which reported the incidence of stroke. Incidence of stroke was compared in patients with and without coronary calcification. Results Three studies evaluated 13,262 asymptomatic patients (mean age = 60 years, 50% men) without apparent cardiovascular diseases. During a follow-up of 7.2 years (median 5 years, range 4.4–9.5 years, 95,434 patient-years), the overall pooled incidence of stroke was 0.26%/year. The pooled risk ratio of CACS > 0 for incident stroke was 2.95 (95% CI: 2.18–4.01, p < 0.001) compared to CACS = 0. The heterogeneity among studies was low (I2 = 0%). The pooled incidence rate of stroke categorized by CACS was 0.12%/year for CACS 0, 0.26%/year for CACS 1–99, 0.41%/year for CACS 100–399 and 0.70%/year for CACS ≥ 400. Conclusions In asymptomatic patients without apparent cardiovascular diseases, the incidence of stroke was overall low. The presence and severity of coronary artery calcification were associated with incident stroke over mid-long term follow-up.

Original languageEnglish (US)
Pages (from-to)473-477
Number of pages5
JournalInternational Journal of Cardiology
StatePublished - Jun 1 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier B.V.


  • Calcium score
  • Cerebrovascular disease
  • Computed angiography
  • Coronary artery disease
  • Coronary calcification
  • Stroke


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