The ratio of the max-to-mean coronary artery calcium score in the most calcified vessel is associated with the presence of coronary artery disease

Purpose: This study aimed to clarify the relationship between the severity of the calcium burden in the most calcified coronary vessel and coronary artery disease (CAD).

Method: Of 2150 patients, 376 examined by both coronary computed tomographic angiography and invasive coronary angiography (ICA) within 30 days at Sun Yat-sen Memorial Hospital between March 2011 and July 2020 were included. Three coronary artery calcium scores (CACSs), including the Agatston score, volume score, and mass score, and other clinical variables were recorded. The ratio of max-to-mean CACS in the most calcified vessel (CACS_max:mean) was defined as the CACS in the most calcified vessel/average CACS of the four major epicardial coronary arteries. Logistic regression and least absolute shrinkage and selection operator (LASSO) analyses were performed to assess the relationship between CACS_max:mean and CAD.

Results: CACS_max:mean was higher in 81.1% of subjects diagnosed with CAD than in subjects without CAD. In multivariate logistic regression analysis, CACS_max:mean determined by the Agatston score, volumetric score, and mass score was associated with CAD. In LASSO analysis, Agatston score_max:mean (not the total Agatston score or other CACS_max:mean) had the strongest correlation with CAD (β = 0.125). AUCs in the training set and the validation set were 0.811 and 0.789, respectively. Increased age, diabetes and hypertension correlated with higher Agatston score_max:mean.

Conclusions: In addition to total CACS, CACS_max:mean may be a novel diagnostic parameter for CAD, showing the calcium burden severity.