Coronary Artery Calcium Score: Assessment of SYNTAX Score and Prediction of Coronary Artery Disease

Abstract

Background With the advent of modern imaging technologies, non-invasive assessment of the coronary system is not only possible but its complexity and plaque burden can be quantified. This study aims to determine whether calcium score on computed tomography coronary angiography (CTCA) can be associated with the complexity of coronary artery disease (CAD), which is determined by the SYNTAX score on coronary angiography, as well as to determine which cut-off value of coronary artery calcium (CAC) score can predict severe CAD in our population. Methodology This was a cross-sectional study conducted at the Rawalpindi Institute of Cardiology, Pakistan from January 2019 to March 2020. The calcium score of all patients with low-to-intermediate pretest probability of CAD was calculated on CTCA. All patients who had significant disease on CTCA were subjected to conventional coronary angiography and SYNTAX score was calculated, which was later used to determine the association between calcium and SYNTAX score. Results A total of 90 patients were included in the study. CAC and SYNTAX score were found to be positively correlated (Pearson coefficient [r] = 0.354; p = 0.001). The total CAC score with a cut-off value of 212 recognized patients with the SYNTAX score of >27. The sensitivity was 66.7% and specificity was 70.5% with an area under the curve of 0.743. The mean calcium score of patients in our study group was 223, with the maximum score of 1,216 and the minimum score of zero. Conclusion A CAC score greater than 212 is associated with a high SYNTAX score indicating complex disease. Only age is an independent predictor of calcium score.

Correlation of 2D echocardiographic calcium score with severity of coronary artery disease assessed by C.T angiography and coronary angiography

“…Concerning the correlation between CC and syntax score, Shabbier et al' found a positive correlation between the score of syntax and the score of ct calcium (r = 0.354, p = 0.001) and confirmed results Syntax score showed a significant positive correlation with the score of CT calcium (r = 0.785 & CT < 0.001) (16).…”

SYNTAX and Coronary Artery Calcium Score Predict Atherosclerotic Plaque Formation in the Ascending Aorta

“…The association of plasma lipid parameters and severity of atherosclerosis in ascending aorta was demonstrated previously by obtaining aortic tissue specimens on the aortic wall. According to a study, the extension of atherosclerosis is positively correlated with plasma TC, LDL-C, and TG concentrations, and negatively correlated with HDL-C concentration [Shabbir 2021].…”

“…A study, in which the thoracic aortic atherosclerotic plaques was diagnosed by transesophageal echocardiography, reported atherosclerotic plaque formation in the thoracic aorta that was 90% sensitive with 90% specificity to predict coronary artery disease [Shabbir 2021]. However, the association between ascending aorta, aortic arch, and coronary arteries was not found to be significant.…”

The Clinical Value of Syntax Scores in Predicting Coronary Artery Disease Outcomes

“…Lee et al [41] have observed a strong relationship between increased exercise capacity after PCI and an integrated anatomical and functional scoring system (residual functional SS). According to Shabbir et al [42], a calculated coronary artery calcium score greater than 212 may be associated with SS. Matos et al [43] have demonstrated that the Gensini score and thrombus burden improve the predictive value of SS in the detection of no-reflow.…”