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Comparing Coronary Artery Calcium Score to Coronary CT Angiography Findings: Is CT Angiography Necessary in All Patients?


avatar Mehrnam Amouei ORCID 1 , avatar Ramezan Jafari ORCID 1 , avatar Houshyar Maghsoudi 1 , avatar Mostafa Vahedian ORCID 2 , avatar Sajjad Rezvan ORCID 3 , * , avatar Saeid Roozpeykar ORCID 1

1 Department of Radiology and Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

2 Department of Social Medicine, Faculty of Medical Sciences, Qom University of Medical Sciences, Qom, IR Iran

3 Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, IR Iran

How to Cite: Amouei M, Jafari R, Maghsoudi H, Vahedian M , Rezvan S, et al. Comparing Coronary Artery Calcium Score to Coronary CT Angiography Findings: Is CT Angiography Necessary in All Patients?. Int Cardio Res J. 2021;15(2):e114659.


International Cardiovascular Research Journal: 15 (2); e114659
Published Online: June 30, 2021
Article Type: Research Article
Received: March 14, 2021
Revised: June 15, 2021
Accepted: July 06, 2021


Background: Ischemic Heart Disease (IHD) is the leading cause of death worldwide.
The primary pathological process resulting in IHD is coronary artery atherosclerosis.
Despite advances in CT scan technology, the Agatson method is still the most popular
method for measuring coronary artery calcification. Various studies have shown that
determining the degree of calcification using Coronary Artery Calcium Score (CACS)
is the most reliable noninvasive method of risk assessment. Coronary CT Angiography
(CCTA) might be required following CACS measurements. However, there is no
consensus regarding a specific CACS cut-off for determining the need for CCTA.
Objectives: This study aimed to compare the severity of coronary calcification to CTA
Methods: This retrospective study was conducted on 261 patients with cardiovascular
risk factors or atypical symptoms. An ECG-gated multi-detector CT scan was performed
to calculate CACS using the Agatston method. Then, CCTA was performed by injection
of the IV contrast agent. The presence of significant coronary artery stenosis was defined
as ≥ 50% diameter reduction in CCTA images. Univariate and multivariate analyses
were performed using binary logistic regression.
Results: Among the patients, 58.2% had no stenosis and 17.6% had significant stenosis.
According to the results of univariate analysis, higher age, hypertension, and lower
estimated Glomerular Filtration Rate (eGFR) were associated with a significant increase
in coronary artery stenosis. Following multivariate analysis, only GFR was suggested as
an independent risk factor, which indicated the important role of GFR as a confounder.
Approximately half of the cases (48.6%) had no calcification (CACS = 0), among whom
only one patient (0.8%) had significant stenosis on CCTA images. In the minimal
subgroup (0 < CACS ≤ 10), one patient (3.1%) showed significant stenosis (P < 0.01). The
results revealed a gradual and independent association between higher CAC scores and
increase in the incidence of significant stenosis.
Conclusions: Due to the low prevalence of significant stenosis in patients with CACS ≤
10, CCTA is not recommended in this group, resulting in less radiation exposure and
reduced health system costs. In patients with CACS > 10, the likelihood of significant
stenosis requiring invasive treatment increases.


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