The Weston Score in coronary artery calcification among patients with End-Stage Renal Disease

To evaluate the relationship between the Weston Score (WS) and the degree of stenosis on coronary angiography (CAG) in patients with End-Stage Renal Disease (ESRD), and to investigate whether the WS for coronary artery calcification (CAC) can aid in the early diagnosis of coronary artery disease.

This retrospective study analyzed chest computed tomography (CT) scans from 105 ESRD patients who underwent CAG between January 2021 and January 2025. The presence and extent of calcium in the main coronary arteries-the left main coronary artery (LMCA), left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA)-were visually assessed. The WS (range 0-12) was calculated by summing the scores for each vessel, with a score of WS ≥ 7 indicating severe calcification. Spearman correlation analysis was used to assess the correlation between the WS and the degree of coronary stenosis (< 50% vs. ≥50%). The predictive value of the WS for significant stenosis was evaluated using receiver operating characteristic (ROC) curve analysis. Agreement between the WS and CAG findings was assessed with the Kappa test. Clinical data were compared between groups based on the WS.

Among the 105 patients, the majority were male (79.05%), with a mean age of 63.44 ± 9.30 years. Unstable angina was the most common cardiovascular event (44.76%), and hypertension was the most frequent comorbidity (82.86%). CAG revealed that severe four-vessel disease (Grade IV) was most common (79.05%), with the LAD being the most severely affected vessel. WS assessment showed the highest calcification prevalence in the LAD (95.24%), with 69% classified as severe. The LMCA had the lowest calcification prevalence (42.86%), with mostly mild calcification. The LCX and RCA had intermediate prevalence, with the LCX having a higher proportion of moderate-to-severe calcification than the RCA. Significant coronary stenosis (≥ 50%) was present in 90.48% of patients, and 66.31% of these had a WS ≥ 5. All 10 patients with stenosis < 50% had a WS < 5. Spearman analysis confirmed significant positive correlations between the WS and stenosis degree for all coronary branches (all P < 0.05), with varying correlation strengths. ROC analysis indicated the highest diagnostic performance for the LMCA (area under the curve [AUC] = 0.878, P < 0.001), followed by the LCX (AUC = 0.737, P < 0.001). The LAD showed statistical significance (AUC = 0.683, P = 0.009), while the RCA had the weakest predictive ability (AUC = 0.608, P = 0.071). The combined WS for all four vessels predicted significant stenosis with an AUC of 0.902 (P < 0.001). The optimal diagnostic cutoff was a score of 5, yielding a sensitivity of 66.3% and specificity of 100%. Furthermore, patients in the WS ≥ 5 group had a lower mean age than those in the WS < 5 group (P = 0.034); dialysis vintage was significantly longer (P = 0.009); and levels of troponin I, creatinine, and serum calcium were all higher than those in the WS < 5 group (all P < 0.05).

WS is significantly positively associated with coronary stenosis severity in ESRD patients. It provides a reliable assessment for LMCA and LCX stenosis but has limited value for the RCA. A WS cutoff of ≥ 5 offers improved identification of coronary stenosis in these patients and can serve as a preliminary screening tool, although CAG remains essential for definitive diagnosis. Age, dialysis vintage, troponin I, creatinine, and serum calcium levels may be associated with CAC in ESRD.