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Published on: August 28, 2018
Efficacy of Coronary Calcium Score in Predicting Coronary Artery Morphology in Patients With Obstructive Coronary
Xingwei He1,2, Soe Maung1, Anantharaman Ramasamy1,3
1Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
Insights
Coronary artery calcium score (CACS) shows limited value in predicting plaque morphology in patients with obstructive coronary artery disease (CAD). CACS is not associated with lipid content or high-risk plaque phenotypes, suggesting caution in its use for symptomatic patients.
Area of Science:
- Cardiology
- Medical Imaging
- Atherosclerosis Research
Background:
- Coronary artery calcium score (CACS) is a recognized marker for coronary artery disease (CAD) risk stratification in asymptomatic individuals.
- The utility of CACS in characterizing plaque morphology among patients with established, obstructive CAD remains less understood.
- This study investigates the relationship between CACS and detailed plaque characteristics identified via near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS).
Purpose of the Study:
- To evaluate the association between CACS derived from coronary computed tomography angiography (CTA) and plaque morphology assessed by NIRS-IVUS.
- To determine if CACS can predict lipid content and high-risk plaque features in patients with obstructive CAD.
Main Methods:
- Seventy patients with obstructive CAD underwent both CTA for CACS measurement and 3-vessel NIRS-IVUS imaging.
- Correlations between CACS and NIRS-IVUS-derived plaque characteristics (atheroma volume, calcific burden, lipid content) were analyzed at both patient and segment levels.
- Linear regression models were used to assess associations at the segment level.
Main Results:
- A weak correlation was observed between CACS and percent atheroma volume (r = 0.271) and a moderate correlation with calcific burden (r = 0.648) at the patient level.
- No significant association was found between CACS and lipid content or the presence of high-risk plaques.
- At the segment level, CACS correlated with total atheroma volume and calcific burden, but not with lipid content or high-risk lesions.
Conclusions:
- In patients with obstructive CAD, CACS does not correlate with plaque lipid content or specific high-risk plaque phenotypes.
- These findings suggest that CACS may have limited utility for cardiovascular risk screening or stratification in symptomatic patients with a high likelihood of CAD.
- Further research is needed to understand the comprehensive role of CACS in advanced CAD.
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.
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