Efficacy of Coronary Calcium Score in Predicting Coronary Artery Morphology in Patients With Obstructive Coronary Artery Disease

Xingwei He; Soe Maung; Anantharaman Ramasamy; Mohamed O Mohamed; Retesh Bajaj; Nathan Angelo Lecaros Yap; Medeni Karaduman; Yaojun Zhang; Pieter Kitslaar; Alexander Broersen; Johan H C Reiber; Jouke Dijkstra; Patrick W Serruys; James C Moon; Andreas Baumbach; Ryo Torii; Francesca Pugliese; Christos V Bourantas

doi:10.1016/j.jscai.2024.101308

Efficacy of Coronary Calcium Score in Predicting Coronary Artery Morphology in Patients With Obstructive Coronary Artery Disease

J Soc Cardiovasc Angiogr Interv. 2024 Mar 26;3(3Part B):101308. doi: 10.1016/j.jscai.2024.101308. eCollection 2024 Mar.

Authors

Xingwei He^{1

2}, Soe Maung¹, Anantharaman Ramasamy^{1

3}, Mohamed O Mohamed^{1

4}, Retesh Bajaj^{1

3}, Nathan Angelo Lecaros Yap¹, Medeni Karaduman⁵, Yaojun Zhang⁶, Pieter Kitslaar^{7

8}, Alexander Broersen⁸, Johan H C Reiber^{7

8}, Jouke Dijkstra⁸, Patrick W Serruys^{9

10}, James C Moon^{1

11}, Andreas Baumbach^{1

3}, Ryo Torii¹², Francesca Pugliese^{1

3}, Christos V Bourantas^{1

3}

Affiliations

¹ Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
² Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
⁴ Institute of Health Informatics, University College London, London, United Kingdom.
⁵ Department of Cardiology, Faculty of Medicine, Yuzuncu Yil University Van, Van, Turkey.
⁶ Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou, China.
⁷ Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
⁸ Medis Medical Imaging Systems, Leiden, the Netherlands.
⁹ Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
¹⁰ Department of Cardiology, University of Galway, Galway, Ireland.
¹¹ Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
¹² Department of Mechanical Engineering, University College London, London, United Kingdom.

Abstract

Background: Coronary artery calcium score (CACS) is an established marker of coronary artery disease (CAD) and has been extensively used to stratify risk in asymptomatic individuals. However, the value of CACS in predicting plaque morphology in patients with advanced CAD is less established. The present analysis aims to assess the association between CACS and plaque characteristics detected by near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) imaging in patients with obstructive CAD.

Methods: Seventy patients with obstructive CAD underwent coronary computed tomography angiography (CTA) and 3-vessel NIRS-IVUS imaging were included in the present analysis. The CTA data were used to measure the CACS in the entire coronary tree and the segments assessed by NIRS-IVUS, and these estimations were associated with the NIRS-IVUS measurements at a patient and segment level.

Results: In total, 65 patients (188 segments) completed the study protocol and were included in the analysis. A weak correlation was noted between the CACS, percent atheroma volume (r = 0.271, P = .002), and the calcific burden measured by NIRS-IVUS (r = 0.648, P < .001) at patient-level analysis. Conversely, there was no association between the CACS and the lipid content, or the incidence of high-risk plaques detected by NIRS. Linear regression analysis at the segment level demonstrated an association between the CACS and the total atheroma volume (coefficient, 0.087; 95% CI, 0.024-0.149; P = .008) and the calcific burden (coefficient, 0.117; 95% CI, 0.048-0.186; P = .001), but there was no association between the lipid content or the incidence of high-risk lesions.

Conclusions: In patients with obstructive CAD, the CACS is not associated with the lipid content or plaque phenotypes. These findings indicate that the CACS may have a limited value for screening or stratifying cardiovascular risk in symptomatic patients with a high probability of CAD.

Keywords: coronary artery disease; coronary calcium score; coronary computed tomography angiography; near-infrared spectroscopy-intravascular ultrasound; risk stratification; vulnerable plaque.