ArticlePloS one2017
Lower limb arterial calcification (LLAC) scores in patients with symptomatic peripheral arterial disease are associated with increased cardiac mortality and morbidity.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 73 citations in OpenAlex.
- Quantification of arterial calcification in peripheral artery disease and its association with amputation and/or mortality: A systematic review.Vascular medicine (London, England) · 2025Pooled it
- Association Between DOAC Exposure and Lower-Extremity Arterial Calcification: A Propensity-Matched Exploratory CT Study.Journal of clinical medicine · 2026Article
- Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Disrupt PAD III Observational Study.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2026Observational
- Peripheral Vascular Calcification.Arteriosclerosis, thrombosis, and vascular biology · 2026Review
- Predictive value of tibial and coronary artery calcification scores for cardiac and lower extremity events.Journal of vascular surgery · 2025Article
- Automated Aneurysm Boundary Detection and Volume Estimation Using Deep Learning.Diagnostics (Basel, Switzerland) · 2025Article
- Calcium Modification During Peripheral Intervention With a Novel Intravascular Lithotripsy System: An Institutional Experience.Journal of the Society for Cardiovascular Angiography & Interventions · 2025Article
- Aneurysm Analysis Using Deep Learning.medRxiv : the preprint server for health sciences · 2025Article
- Metabolic dysfunction-associated steatotic liver disease (MASLD) biomarkers and progression of lower limb arterial calcification in patients with type 2 diabetes: a prospective cohort study.Cardiovascular diabetology · 2025Observational
- Imaging Characterisation of Peripheral Artery Disease: A Scoping Review on Current Classifications and New Insights Brought by Artificial Intelligence.EJVES vascular forum · 2025Review
- Aortic calcium score predicts early outcomes in aortoiliac revascularization.Einstein (Sao Paulo, Brazil) · 2025Article
- Sex-Specific Association Patterns of Bone Microstructure and Lower Leg Arterial Calcification.Calcified tissue international · 2024Article
- The Association between Fatty Liver Index and Lower Limb Arterial Calcification in Patients with Type 2 Diabetes Mellitus.Reviews in cardiovascular medicine · 2024Article
- Calcification Formation for Development, Defense, and Repair of the Human Body?Journal of clinical medicine · 2024Article
- Objective Methods to Assess Aorto-Iliac Calcifications: A Systematic Review.Diagnostics (Basel, Switzerland) · 2024Review
- Clinical Utility of Infrapopliteal Calcium Score for the Evaluation of Severity of Peripheral Artery Disease.Journal of vascular and interventional radiology : JVIR · 2024Article
- Article
- Automated Measurement of Vascular Calcification in Femoral Endarterectomy Patients Using Deep Learning.Diagnostics (Basel, Switzerland) · 2023Article
- Article
- Detection of multivessel calcific disease progression in a patient with chronic limb-threatening ischemia using fluorine-18 sodium fluoride positron emission tomography imaging.Journal of vascular surgery cases and innovative techniques · 2023Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
Abstract
aimsThe association of coronary arterial calcification with cardiovascular morbidity and mortality is well-recognized. Lower limb arterial calcification (LLAC) is common in PAD but its impact on subsequent health is poorly described. We aimed to determine the association between a LLAC score and subsequent cardiovascular events in patients with symptomatic peripheral arterial disease (PAD).
methodsLLAC scoring, and the established Bollinger score, were derived from a database of unenhanced CT scans, from patients presenting with symptomatic PAD. We determined the association between these scores outcomes. The primary outcome was combined cardiac mortality and morbidity (CM/M) with a secondary outcome of all-cause mortality.
results220 patients (66% male; median age 69 years) were included with follow-up for a median 46 [IQR 31-64] months. Median total LLAC scores were higher in those patients suffering a primary outcome (6831 vs. 1652; p = 0.012). Diabetes mellitus (p = 0.039), ischaemic heart disease (p = 0.028), chronic kidney disease (p = 0.026) and all-cause mortality (p = 0.012) were more common in patients in the highest quartile of LLAC scores. The area under the curve of the receiver operator curve for the LLAC score was greater (0.929: 95% CI [0.884-0.974]) than for the Bollinger score (0.824: 95% CI [0.758-0.890]) for the primary outcome. A LLAC score ≥ 4400 had the best diagnostic accuracy to determine the outcome measure.
conclusionThis is the largest study to investigate links between lower limb arterial calcification and cardiovascular events in symptomatic PAD. We describe a straightforward, reproducible, CT-derived measure of calcification-the LLAC score.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.