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Furthermore, non-survivors showed worse development of multi-organ failure over time compared to survivors with COVID-19. Nevertheless, it remains unclear whether more CAC is associated with worse long-term survival. Therefore, we studied the association between CAC and one-year survival. In a prospective cohort of 241 mechanically ventilated patients who underwent chest CT scans for clinical evaluation of critical disease, CAC was scored using a semi-quantitative 12-point grading system. Cox proportional hazards analyses were used to investigate the association between CAC score (continuous and tertiles) and one-year survival in crude models and models adjusted for risk factors. In the crude model, a 1-point higher CAC score was associated with a higher hazard ratio (HR) (with 95% confidence interval (CI)) of 1.13 (95%CI: 1.08;1.19, p-value: &lt;0.001). Compared to the lowest tertile (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200985), a higher mortality was shown for the medium (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200981) and the highest (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200975) tertiles, HR 1.21 (95%CI: 0.73;2.02, p-value:0.443) and HR 3.32 (95%CI: 2.10;5.27, p-value:&lt;0.001), respectively. After adjustment for age, sex and APACHE-II score, and comorbidities, a higher CAC score was associated with statistically significant worse one-year survival HR 2.07 (95% CI: 1.18\u20133.63, p-value:0.012). More coronary artery calcifications (CAC) are associated with worse one-year survival in patients on mechanical ventilation for severe COVID-19.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-40733-x","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T22:04:17Z","timestamp":1771625057000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Coronary artery calcification is associated with reduced survival in mechanically ventilated COVID-19 patients in the MaastrICCht cohort"],"prefix":"10.1038","volume":"16","author":[{"given":"Esmee","family":"Baldussu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd","family":"Brandts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Pennetta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"van Rosmalen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanke J.","family":"Schalkx","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn W.","family":"Smulders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iwan C.C.","family":"van der Horst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim E.","family":"Wildberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thijs T.W.","family":"van Herpt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casper","family":"Mihl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas C.T.","family":"van Bussel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bibi","family":"Martens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob G.H.","family":"Driessen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"issue":"5","key":"40733_CR1","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1007\/s00392-020-01626-9","volume":"109","author":"B Li","year":"2020","unstructured":"Li, B. et al. 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