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Relationship Between Baseline Coronary Calcium Score and Demonstration of Coronary Artery Stenoses During Follow-Up

MESA (Multi-Ethnic Study of Atherosclerosis)

Boaz D. Rosen, MD^_*, Veronica Fernandes, MD, PhD^_*, Robyn L. McClelland, PhD, Jeffrey J. Carr, MD, MSCE, Robert Detrano, MD^||, David A. Bluemke, MD, PhD, João A.C. Lima, MD^_*,,_*

^_* Cardiology Division, Johns Hopkins Medical Institutions, Baltimore, Maryland
Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
University of Washington, Seattle, Washington
Wake Forest University School of Medicine, Winston-Salem, North Carolina
^|| UCLA School of Medicine, Torrance, California

^_* Reprint requests and correspondence: Dr. João A. C. Lima, Cardiology Division, Blalock 52469, Johns Hopkins Hospital, 600N Wolfe Street, Baltimore, Maryland 21287-6568 (Email: jlima{at}jhmi.edu).

Objectives: The MESA (Multi-Ethnic Study of Atherosclerosis) is a population-based study of 6,814 men and women. We sought to analyze the relationship between the extent of coronary artery calcium (CAC) at baseline and the severity of coronary stenoses in clinically indicated coronary angiography studies during follow-up.

Background: CAC is an established predictor of major cardiovascular events. Yet, the relationship between CAC and the distribution and severity of coronary artery stenoses has not been widely explored.

Methods: All MESA participants underwent noncontrast enhanced cardiac computed tomography during enrollment to determine baseline CAC. We analyzed 175 consecutive angiography reports from participants who underwent coronary catheterization for clinical indications during a median follow-up period of 18 months. The relationship between baseline CAC and the severity of coronary stenosis detected in coronary angiographies was determined.

Results: Baseline Agatston score was 0 in only 7 of 175 (4%) MESA participants who underwent invasive angiography during follow-up. When coronary arteries were studied separately, 13% to 18% of coronary arteries with 75% stenosis had 0 calcium mass scores at baseline. There was close association between baseline calcium mass score and the severity of stenosis in each of the coronary arteries (test for trend, p < 0.001). For example, mean calcium mass scores for <50%, 50% to 74%, and 75% stenosis in the left anterior descending coronary artery were 105.1 mg, 157.2 mg, and 302.2 mg, respectively (p < 0.001). Finally, there was a direct relationship between the total Agatston Score at baseline and the number of diseased vessels (test for trend, p < 0.001).

Conclusions: The majority of patients with clinically indicated coronary angiography during follow-up had detectable coronary calcification at baseline. Although there is a significant relationship between the extent of calcification and mean degree of stenosis in individual coronary vessels, 16% of the coronary arteries with significant stenoses had no calcification at baseline.

Key Words: angiography • coronary calcium • coronary stenoses • MESA

Abbreviations and Acronyms   CAC = coronary artery calcium   CACP = coronary artery calcium plaque   CAD = coronary artery disease   CT = computed tomography   EBCT = electron beam computed tomography   LAD = left anterior descending   LCX = left circumflex   LMCA = left main coronary artery   LV = left ventricle   RCA = right coronary artery

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