This study investigated the progression of coronary artery calcification (CAC) and its association with adverse cardiovascular events (ACEs) in participants of the Korean Lung Cancer Screening (LCS) program using low-dose chest CT (LDCT). A total of 193 male participants were followed for an average of 4 years. Greater baseline CAC severity predicted a faster annual CAC score increase. Among baseline CAC-negative individuals, 20.9% developed incident CAC, and 44.1% of baseline-positive participants showed CAC progression. AI-based software (AVIEW CAC by Coreline Soft) using the Agatston method was used for CAC scoring. Patients with CAC growth showed a significantly higher rate of ACEs. This study suggests that AI-assisted longitudinal CAC tracking via LDCT can provide meaningful prognostic value and may guide individualized cardiovascular risk assessment and follow-up strategies in clinical practice.
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