Background Cancer patients are at increased risk of cardiovascular disease (CVD) after treatment with potentially cardiotoxic treatments. Many cancer patients undergo non-gated chest CT (NCCT) for cancer staging prior to treatment. Aims We aimed to assess whether coronary artery calcification (CAC) on NCCT predicts CVD risk in cancer patients. Methods 603 patients (mean age: 61.3 years, 30.8% male) with either breast cancer, lymphoma or sarcoma were identified retrospectively. Primary endpoint was a MACE composite including non-fatal myocardial infarction (MI), new heart failure (HF) diagnosis, HF hospitalization and cardiac death, with Fine-Gray analysis for non-cardiac death as competing risk. Secondary endpoints included a coronary composite and a HF composite. Results CAC was present in 194 (32.2%) and clinically reported in 85 (43.8%) patients. At a median follow-up of 5.3 years, 256 (42.5%) patients died of non-cardiac causes. CAC presence or extent was not an independent predictor of MACE (SHR 1.28; 0.73-2.27). CAC extent was a significant predictor of the coronary composite outcome (SHR per 2-fold increase 1.14; 1.01-1.28), but not of the HF composite outcome (SHR per 2-fold increase 1.04; 0.95-1.14). Conclusion CAC detected incidentally on NCCT scans in cancer patients is prevalent and often not reported. CAC presence or extent did not independently predict MACE. CAC extent was independently associated with increased risk of CAD events but not HF events.

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