JSMC-10393

CORRELATION OF CORONARY CALCIUM SCORE AND ANGIOGRAPHIC FINDINGS IN PATIENTS WITH ISCHEMIC HEART DISEASE

Dana Mohammed Saeed a, Kawa Tahir Rahim b,  and Ferman J. Ahmed b

a Sulaimani Cardiac Hospital, Sulaimani, Kurdistan Region, Iraq
b College of Medicine, University of Sulaimani, Kurdistan Region, Iraq

Submitted: 25/6/2022; Accepted: 20/12/2022; Published: 21/3/2023

DOI Link: https://doi.org/10.17656/jsmc.10393 

---------------------------------------------------------------------------------------------------------------------------------------------------------------

ABSTRACT

Background 

Acute myocardial infarction and sudden cardiac death was reported to be the initial presentation in 50% of patients with coronary artery disease (CAD); coronary artery calcium score can be regarded as one of the potential tools to improve risk stratification and predict coronary events in these patients.

Objectives 

To find the correlation between coronary calsuim score calculated by CT scan and significant coronary stenosis by conventional coronary angiography.

Materials and Methods

A hundred patients who were referred for conventional coronary angiography having CAC score calculated by CT scan, 50 patients with CAC <400 and 50 patients with >400 were randomly selected to be involved.

Results

The age ranged from 32 to 70 years with a mean of 56.7 ±8.9. There were 59 males with 41 females. Chest pain was our study’s main reason for undergoing imaging (67%). The mean coronary calcium score was 528.54 for total coronary vessels and 19,236.8, 115.45 and 157.98 for LMS, LAD, LCX and RCA, respectively. The mean of the calculated syntax score was 23.4. Stenosis of >50% was 9% for LMS, and stenosis of ≥75% was found in 41%, 27%, and 8% of LAD, LCX and RCA, respectively. A significant correlation between total coronary calcium score at a threshold of 400 and age, being diabetic, LAD stenosis, LCX stenosis, RCA stenosis, mean syntax score and syntax score categories. Also, the mean total coronary calcium score was significantly correlated to age, gender and syntax score. Moreover, the stenosis in LAD, LCX and RCA was significantly correlated to the mean of the calcium score of respective vessels. 

Conclusion

Total CAC score was significantly associated with angiographic coronary stenosis, and the correlation is stronger at 400 and above. This study may support using calcium screening as an initial filter before further sophisticated imaging or invasive angiography. However, a zero or low CACS does not exclude CAD.

KEYWORDS

 Total coronary calcium score, Coronary artery disease, Coronary artery stenosis.

References 

1-W. B. Kannel and A. Schatzkin, “Sudden death: lessons from subsets in population studies,” Journal of the American College of Cardiology, 1985; 5(6):141B–149B.

2-M. J. Budoff and K. M. Gul, “Expert review on coronary calcium,” Vascular Health and Risk Management, 2008;4(2):315–324.

3-C. C. Chen, C. C. Chen, I. C. Hsieh , "The effect of calcium score on the diagnostic accuracy of coronary computed tomography angiography," International Journal of Cardiovascular Imaging, 2011;27(1): 37–42.

4-A. S. Agatston,W. R. Janowitz, F. J. Hildner, N. R. Zusmer,M. Viamonte, and R. Detrano, "Quantifying coronary artery calcium using ultrafast computed tomography," Journal of the American College of Cardiology, 1990;15(4): 827–832.

5-Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R: Quantifying coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15:827–32.

6-Capodanno D: Syntax score: reaching optimal revascularisation for complex coronary artery disease. JCardiol Pract. 2009, 8:5.

7. Gaemperli O, Husmann L, Schepis T, Koepfli P, Valenta I, Jenni W,et al: Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: a potential gatekeeper for coronary revascularization? Eur Heart J 2009; 30:2921–9.

8. Kelly JL, Thickman D, Abramson SD, Chen PR, Smazal SF, Fleishman MJ, et al: Coronary CT angiography findings in patients without coronary calcification. AJR Am J Roentgenol 2008, 191:50–5.

9. Rosen BD, Fernandes V, McClelland RL, Carr JJ, Detrano R, Bluemke DA, Lima JA. Relationship between baseline coronary calcium score and demonstration of coronary artery stenoses during follow-up MESA (Multi-Ethnic Study of Atherosclerosis). JACC Cardiovasc Imaging. 2009 Oct;2(10):1175-83. 

10. Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C, Brüning R, Reiser M, Steinbeck G. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol. 2001 Feb;37(2):451-7

11. Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, Stanford W, Shields P,Lewis RJ, Janowitz WR, Rich S, Brundage BH. Ultrafast computed tomography as a diagnostic modality in detecting coronary artery disease: a multicenter study. Circulation 1996; 93:898–904. 

12. Budoff MJ, Diamond GA, Raggi P, Arad Y, Guerci AD, Callister TQ, Berman D. Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography. Circulation 2002; 105:1791–1796.

13. Berman D, Wong N, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes S, Friedman J, Kang X, Polk D, Hachamovitch R, Shaw L, Rozanski A. Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol 2004; 44:923–930.

14. Ho JS, Fitzgerald SJ, Stolfus LL, Wade WA, Reinhardt DB, Barlow CE, Cannaday JJ. Relation of a coronary artery calcium score higher than 400 to coronary stenoses detected using multidetector computed tomography and to traditional cardiovascular risk factors. Am J Cardiol. 2008 May 15;101(10):1444-7

15. Shabbir A, Virk ST, Malik J, Kausar S, Nazir TB, Javed A. Coronary Artery Calcium Score: Assessment of SYNTAX Score and Prediction of Coronary Artery Disease. Cureus. 2021 Jan 14;13(1): e12704. 

Full Text