AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Predictive Value of Coronary Artery Calcification on the Baseline PET/CT or Chest CT for MACE in Female Patients with Breast Cancer
By Gomez Ardila MF, Perez Nuques MJ, Villa Pallares EA et al.
Background: Breast cancer (BC) is the most common malignancy among women worldwide. As advances in cancer treatment have improved survival; cardiovascular disease has emerged as an important cause of morbidity and mortality among BC survivors. Coronary artery calcifications (CAC) and calcifications in the aorta (CA) are established markers of cardiovascular risk, but their prognostic significance with Major adverse cardiovascular events (MACE)—defined as acute myocardial infarction, acute coronary syndrome/ischemic heart disease requiring revascularization, stroke, and cardiovascular death—remains incompletely understood. Purpose: Determine if the presence of CAC or CA on baseline PET/CT (Positron Emission Tomography-Computed Tomography) or chest CT predicts MACE. Methods: Retrospective cohort study of female patients diagnosed with BC between January 1, 2005, and December 31, 2015, and followed until 12/31/2025. Treatment included surgery, hormone therapy, chemotherapy (CTX) or radiation (RTX) therapy. CTX (anthracycline +/-trastuzumab). Baseline PET/CT or chest CT were reviewed for the presence of CAC+/-CA. Patients were excluded if they lacked baseline imaging or had experienced a MACE before treatment. Univariate and multivariate adjusted Cox regression models were used to evaluate associations between CAC/CA and MACE. Kaplan-Meier survival analyses were performed to assess event-free survival. Results: 896 female patients with BC were included (mean age: 74 years, IQR: 65-84), Follow up median 15.1 years (IQR: 10.3-17.1), white (826 [92.2%]). Estrogen receptor (ER+) was identified in 894 (98.3%) patients and progesterone receptor (PR+) in 890 (99.3%). Surgery in 885 (98.3%), RTX in 100%, CTX in 359 (40.1%), and hormone therapy in 618 (69.0%). CAC was identified in 311 (34.7%) patients and CA in 194 (21.7%). The presence of CAC was significantly associated with MACE (HR: 1.52 [95% CI: 1.2-2.0], p=0.0016) (Fig. a). On multivariable analysis, CAC remained the strongest predictor of MACE after adjusting for age, hypertension, diabetes, dyslipidemia, estrogen receptor status, and progesterone receptor status (HR: 1.40 [95% CI: 1.1-1.9], p<0.001) (Fig. c). No significant association was found between CA and MACE (p>0.05) (fig. b). Conclusion: These findings support the value of CAC as a non-invasive cardiovascular risk marker for MACE in BC patients and identify individuals who could benefit from closer cardiovascular surveillance during and after cancer treatment.