Elevated Iliac Calcium Score as a Marker of Coronary Calcification and Overall Atherosclerotic Risk

The initial assessment of cardiovascular risk in patients undergoing lower limb revascularization surgery is crucial to minimize complications and improve outcomes. This study aims to determine if the iliac calcium score (ICS) serves as a cardiologic risk marker by examining its correlation with the coronary calcium score (CCS) in these patients.

This prospective observational single-center study included 248 patients with critical limb ischemia undergoing revascularization procedures from January 2022 to June 2023. Baseline characteristics such as age, gender, smoking status, comorbidities, and clinical status were recorded. CCS and ICS were calculated using preoperative computed tomography angiography. Multiple linear regression identified significant predictors of ICS, including CCS, iliac intima-media thickness (i-IMT), coronary artery disease, diabetes, chronic kidney disease, hypertension, dyslipidemia, and smoking.

The study population had a mean age of 74.4 years, 83.86% male. Significant correlations were found between ICS and CCS (Pearson r = 0.34, P < 0.001) and between ICS and i-IMT (Pearson r = 0.35, P < 0.001). Regression analysis revealed significant predictors for ICS, including CCS (coefficient = 1.808, P < 0.0001), i-IMT (coefficient = 3.11, P < 0.0001), coronary artery disease (coefficient = 11.94, P = 0.042), diabetes (coefficient = 19.59, P = 0.002), chronic kidney disease (coefficient = 11.79, P < 0.0001), and hypertension (coefficient = 22.10, P = 0.001). Dyslipidemia and smoking did not show significant associations with ICS.

The ICS shows a statistically significant association with the CCS and i-IMT in patients undergoing lower limb revascularization surgery. This correlation suggests that ICS reflects vascular calcification patterns like those observed in coronary arteries. Further studies are needed to explore this relationship in diverse patient populations and under varying clinical conditions.