CORONARY ARTERY CALCIFICATION
Authors: Ali Liaqat , Asghar Naeem , Nazim Muhammad , Hussain Maqbool , Farahe Ali 
Published: September 2021

Background: Due to increased risk of CAD and cardiovascular events,prediction of severity and/ or complexity of coronary artery disease (CAD) are valuable.Previously association between severity of CAD and total coronary artery calcium (CAC) scorewas not demonstrated but now there are lot of studies which have proven this associationbut still association between total CAC score and complexity of CAD is not well established.Objective: This study was conducted: (1) To investigate the association between coronaryartery calcium (CAC) score and CAD assessed by CCTA. (2) To find which one of the two, CADseverity or complexity, is better associated with total CAC score in symptomatic patients havingsignificant CAD. Study Design: Observational cross sectional study. Place and Duration: Thestudy was conducted at Shifa International Hospital Faisalabad from March 2013 to June 2016.Materials and Methods: Total 195 consecutive patients of both gender age ≥20 years whowas referred for CT angiography to our hospital and who fulfill the inclusion and exclusioncriteria was included in the study. Before enrollment in the study all patients gave informedconsent. Before CT angiography total CAC score was obtained by non- enhanced CT scans.Demographic characteristics of all patients were obtained. Regarding risk factors for CAD,history of hypertension, diabetes mellitus, family H/O ischemic heart disease and hyperlipidemiawas noted. In all patients before CT angiography, Lab. investigations including complete bloodcount, fasting blood sugar, fasting lipid profile, blood urea and serum creatinine levels wereobtained. Calcium scores were quantified by the scoring algorithm proposed by Agatston et al.All lesions were added to calculate the total CAC score by the Agatston method. Calcium scoreswere divided into the following categories: 0, 1–100, 101–400, and ≥400. The degree of stenosiswas classified into four categories: (1) no stenosis, (2) minimal or mild stenosis (≤50%), (3)moderate stenosis (50%–70%), and (4) severe stenosis (>70%). CAD was defined when lumendiameter reduction was greater than 50% (moderate or severe stenosis). Results: Total 195patients were studied. 136 (69.7%) were male and 59 (30.3%) were female. Mean age of studypopulation was 52.8±10.38 years. 81(41.54%) patients had H/O chest pain, 11(5.64%) hadH/O shortness of breath and 96(49.23%) presented with chest tightness. 104(53.33%) patientswere hypertensive, 71(36.41%) were diabetic, 67(34.35%) had increased cholesterol level. In57 (29.2%) there was no coronary artery disease, 58(29.7%) had mild CAD, 32 (16.4%) hadmoderate and 48 (24.6%) had severe coronary artery disease on CT angiography. Single vesselwas involved in 38(19.5%) patients, 20(10.3%) had two vessel disease and triple vessel diseasewas present in 22(11.3%) patients. 104(53.3%) patients had zero calcium score. 44(22.6%)had CAC score between 1-100, 37 (19%) had CAC score between 101-400 and more than 400CAC score was documented in 10 (5.1%) patients. Conclusions: This study in addition topatient based analysis also confirms the significant relationship between vessels based CADand CAC score. The prevalence of multivessel CAD increased in patients with CACS >100 andthere is 100% incidence of CAD in patients with CACS >1000. Zero calcium cannot exclude thepresence of significant CAD. Our data supports that in symptomatic patients calcium scoring isan additional filter before coronary angiography.