Abstract
BackgroundWith the advent of modern imaging technologies, non-invasive assessment of the coronary system is not only possible but its complexity and plaque burden can be quantified. This study aims to determine whether calcium score on computed tomography coronary angiography (CTCA) can be associated with the complexity of coronary artery disease (CAD), which is determined by the SYNTAX score on coronary angiography, as well as to determine which cut-off value of coronary artery calcium (CAC) score can predict severe CAD in our population.MethodologyThis was a cross-sectional study conducted at the Rawalpindi Institute of Cardiology, Pakistan from January 2019 to March 2020. The calcium score of all patients with low-to-intermediate pretest probability of CAD was calculated on CTCA. All patients who had significant disease on CTCA were subjected to conventional coronary angiography and SYNTAX score was calculated, which was later used to determine the association between calcium and SYNTAX score.ResultsA total of 90 patients were included in the study. CAC and SYNTAX score were found to be positively correlated (Pearson coefficient [r] = 0.354; p = 0.001). The total CAC score with a cut-off value of 212 recognized patients with the SYNTAX score of >27. The sensitivity was 66.7% and specificity was 70.5% with an area under the curve of 0.743. The mean calcium score of patients in our study group was 223, with the maximum score of 1,216 and the minimum score of zero.ConclusionA CAC score greater than 212 is associated with a high SYNTAX score indicating complex disease. Only age is an independent predictor of calcium score.
Highlights
Coronary artery disease (CAD) is one of the major causes of morbidity and mortality worldwide, and the people of the subcontinent are more susceptible to this disease [1,2,3]
Several registries and randomized trials have assessed the role of computed tomography coronary angiography (CTCA) in assessing the presence of coronary artery disease (CAD), defining its severity and complexity, possibly guiding decision-making, and potentially reducing cardiovascular events compared with the current standards [8,9,10]
The objective of this study was to determine the association of CAC with the severity and complexity of CAD on angiography with the help of the SYNTAX score, as well as to determine independent factors associated with the calcium score
Summary
Coronary artery disease (CAD) is one of the major causes of morbidity and mortality worldwide, and the people of the subcontinent are more susceptible to this disease [1,2,3]. SYNTAX score can predict major adverse cardiovascular events, which is a key factor in morbidity and mortality [6]. Several registries and randomized trials have assessed the role of computed tomography coronary angiography (CTCA) in assessing the presence of CAD, defining its severity and complexity, possibly guiding decision-making, and potentially reducing cardiovascular events compared with the current standards [8,9,10]. This is of relevant clinical significance in busy tertiary care cardiac centers in Pakistan due to overburdened catheter labs. This study aims to determine whether calcium score on computed tomography coronary angiography (CTCA) can be associated with the complexity of coronary artery disease (CAD), which is determined by the SYNTAX score on coronary angiography, as well as to determine which cut-off value of coronary artery calcium (CAC) score can predict severe CAD in our population
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