Aortic Arch Calcification, Plaque Morphology, and the Modified Glasgow Prognostic Score as Predictors of Major Adverse Cardiovascular Events

Aortic arch atherosclerosis is a marker of systemic vascular disease and may contribute to adverse cardiovascular outcomes. The modified Glasgow Prognostic Score (mGPS), reflecting systemic inflammation, may influence plaque vulnerability. The present study aimed to investigate the relationship between aortic arch calcification (AAC), aortic arch morphology (AAM), and mGPS, and to evaluate their prognostic significance for major adverse cardiovascular events (MACE). A total of 516 patients who underwent computed tomography angiography (CTA) were retrospectively analyzed. AAC was categorized as none, small, or considerable, and AAM as none, smooth, ulcerated, or protruding. MACE was defined as all-cause mortality, myocardial infarction, or stroke. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to identify predictors of MACE. During a median follow-up 42 MACE occurred. Event-free survival progressively declined with increasing AAC and AAM severity (log-rank P < .001 for both). In multivariable Cox analysis, small and considerable AAC independently predicted MACE ( P = .007 and P = .005). Similarly, smooth, ulcerated, and protruding plaques were associated with significantly higher risk (all P < .01). Although mGPS correlated with plaque complexity, it was not an independent predictor of MACE. CTA-based assessment of aortic arch features may enhance long-term cardiovascular risk stratification.