Exploration of Cardiology

Table 3. Cumulative BCS vs. cumulative Agatston score

AU	BCS < 1 n (%)	BCS ≥ 1 n (%)	P–value
0–200	32 (38.6)	7 (10.3)	< 0.0001^b
201–400	16 (19.3)	7 (10.3)
401–999	16 (19.3)	22 (32.4)
≥ 1,000	19 (22.9)	32 (47.1)
Total	83 (100)	68 (100)

Return to article view

^b χ² test was used

Note. Adapted with permission from “37 Coronary calcification on coronary angiography versus agatston score - does it matter?” by Zathar Z, Pandit M, Notghi A, Sharma V, Karunatilleke A. Heart. 2023;109:A42–3 (https://heart.bmj.com/content/109/Suppl_3/A42). © 2023 BMJ Publishing Group Ltd & British Cardiovascular Society.

Declarations

Author contributions

ZZ: Conceptualization, Methodology, Data curation, Formal analysis, Writing—original draft. MP: Methodology, Resources, Writing—review & editing. AK: Data curation, Resources. AN: Methodology, Resources, Writing—review & editing. VS: Conceptualization, Methodology, Formal analysis, Writing—review & editing, Supervision. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the local audit committee and conducted as a local service improvement project (approval number 2040, Sandwell General Hospital, West Bromwich). This study adhered to the principles of the Declaration of Helsinki and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Consent to participate

Consent from participants is waived as the project is a retrospective study undertaken as an audit with local governance.

Consent to publication

Not applicable.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Funding

Not applicable.

Copyright

References

Detrano R, Hsiai T, Wang S, Puentes G, Fallavollita J, Shields P, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol. 1996;27:285–90. [DOI] [PubMed]

Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–45. [DOI] [PubMed]

Goodman WG, London G, Amann K, Block GA, Giachelli C, Hruska KA, et al.; Vascular Calcification Work Group. Vascular calcification in chronic kidney disease. Am J Kidney Dis. 2004;43:527–9. [DOI] [PubMed]

Mintz GS, Douek P, Pichard AD, Kent KM, Satler LF, Popma JJ, et al. Target lesion calcification in coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol. 1992;20:1149–55. [DOI] [PubMed]

Mintz GS. Intravascular imaging of coronary calcification and its clinical implications. JACC Cardiovasc Imaging. 2015;8:461–71. [DOI] [PubMed]

Lee MS, Shah N. The impact and pathophysiologic consequences of coronary artery calcium deposition in percutaneous coronary interventions. J Invasive Cardiol. 2016;28:160–7. [PubMed]

Sheikh AS, Connolly DL, Sharma V. Acute coronary syndrome associated with calcified coronary lesions. Int J Cardiovasc Dis Diagn. 2021;6:025–33.

Sharma V, Mughal L, Dimitropoulos G, Sheikh A, Griffin M, Moss A, et al. The additive prognostic value of coronary calcium score (CCS) to single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI)-real world data from a single center. J Nucl Cardiol. 2021;28:2086–96. [DOI] [PubMed]

Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Tseng PH, Flores FR, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49:1860–70. [DOI] [PubMed]

10.

Criqui MH, Denenberg JO, Ix JH, McClelland RL, Wassel CL, Rifkin DE, et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events. JAMA. 2014;311:271–8. [DOI] [PubMed] [PMC]

11.

Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291:210–5. [DOI] [PubMed]

12.

Hill JM, Kereiakes DJ, Shlofmitz RA, Klein AJ, Riley RF, Price MJ, et al. Intravascular lithotripsy for treatment of severely calcified coronary artery disease. J Am Coll Cardiol. 2020;76:2635–46. [DOI] [PubMed]

13.

Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, et al. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: a bivariate meta-analysis. Circ Cardiovasc Imaging. 2012;5:700–7. [DOI] [PubMed]

14.

George RT, Mehra VC, Chen MY, Kitagawa K, Arbab-Zadeh A, Miller JM, et al. Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head-to-head comparison from the CORE320 multicenter diagnostic performance study. Radiology. 2014;727:407–16. [DOI] [PubMed] [PMC]

15.

Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol. 2004;11:171–85. [DOI] [PubMed]

16.

Blumenthal RS, Becker DM, Moy TF, Coresh J, Wilder LB, Becker LC. Exercise thallium tomography predicts future clinically manifest coronary heart disease in a high-risk asymptomatic population. Circulation. 1996;93:915–23. [DOI] [PubMed]

17.

Sharma V, Rahman M, Elangovan SK, Yuan M, O’Kane P, Talwar S, et al. Rotashock therapy: an observational study. J Cardiol Clin Res. 2021;9:1169.

18.

Sharma V, Abdul F, Haider ST, Din J, Talwar S, O’Kane P, et al. Rotablation in the very elderly – safer than we think? Cardiovasc Revasc Med. 2021:36–41. [DOI] [PubMed]

19.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573–7. Erratum in: Ann Intern Med. 2008;148:168. [DOI] [PubMed]

20.

World Medical Association. World Medical Association declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Med Assoc. 2013;310:2191–4. [DOI] [PubMed]

21.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74. [PubMed]

22.

Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc. 1999;74:243–52. [DOI] [PubMed]

23.

Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Russ J Cardiol. 2020;25:3757. Russian. [DOI]

24.

Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of cardiology/American heart association task force on practice guidelines. Circulation. 2014;29:S49–73. [DOI] [PubMed]

25.

Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study. Circulation. 1996;93:898–904. [DOI] [PubMed]

26.

Budoff MJ, Diamond GA, Raggi P, Arad Y, Guerci AD, Callister TQ, et al. Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography. Circulation. 2002;105:1791–6. [DOI] [PubMed]

27.

Rumberger JA, Sheedy PF 3rd, Breen JF, Schwartz RS. Coronary calcium, as determined by electron beam computed tomography, and coronary disease on arteriogram. Effect of patient’s sex on diagnosis. Circulation. 1995;91:1363–7. [DOI] [PubMed]

28.

Rosen BD, Fernandes V, McClelland RL, Carr JJ, Detrano R, Bluemke DA, et al. Relationship between baseline coronary calcium score and demonstration of coronary artery stenoses during follow-up: MESA (multi-ethnic study of atherosclerosis). JACC Cardiovasc Imaging. 2009;2:1175–83. [DOI] [PubMed] [PMC]

29.

Schmermund A, Möhlenkamp S, Baumgart D, Kriener P, Pump H, Grönemeyer D, et al. Usefulness of topography of coronary calcium by electron-beam computed tomography in predicting the natural history of coronary atherosclerosis. Am J Cardiol. 2000;86:127–32. [DOI] [PubMed]

30.

Lau GT, Ridley LJ, Schieb MC, Brieger DB, Freedman SB, Wong LA, et al. Coronary artery stenoses: detection with calcium scoring, CT angiography, and both methods combined. Radiology. 2005;235:415–22. [DOI] [PubMed]

31.

Ho JS, FitzGerald SJ, Stolfus LL, Wade WA, Reinhardt DB, Barlow CE, et al. Relation of a coronary artery calcium score higher than 400 to coronary stenoses detected using multidetector computed tomography and to traditional cardiovascular risk factors. Am J Cardiol. 2008;101:1444–7. [DOI] [PubMed]

32.

Berman DS, Wong ND, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes SW, et al. Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol. 2004;44:923–30. [DOI] [PubMed]

33.

Nerlekar N, Ha FJ, Cheshire C, Rashid H, Cameron JD, Wong DT, et al. Computed tomographic coronary angiography–derived plaque characteristics predict major adverse cardiovascular events: a systematic review and meta-analysis. Circ Cardiovasc Imaging. 2018;11:e006973. [DOI] [PubMed]

34.

Puchner SB, Liu T, Mayrhofer T, Truong QA, Lee H, Fleg JL, et al. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol. 2014;64:684–92. [DOI] [PubMed] [PMC]

35.

Hu MK, Yuan M, James S, Lee HP, Abdul F, Yousif A, et al. Positive remodelling of coronary arteries on computed tomography coronary angiogram: an observational study. AsiaIntervention. 2022;8:110–5. [DOI] [PubMed] [PMC]

36.

van Velzen JE, de Graaf FR, de Graaf MA, Schuijf JD, Kroft LJ, de Roos A, et al. Comprehensive assessment of spotty calcifications on computed tomography angiography: comparison to plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis. J Nucl Cardiol. 2011;18:893–903. [DOI] [PubMed] [PMC]

37.

Hecht HS. Coronary artery calcium scanning: past, present, and future. JACC Cardiovasc Imaging. 2015;8:579–96. [DOI] [PubMed]

38.

Rocha-Singh KJ, Zeller T, Jaff MR. Peripheral arterial calcification: prevalence, mechanism, detection, and clinical implications. Catheter Cardiovasc Interv. 2014;83:E212–20. [DOI] [PubMed] [PMC]

39.

Zettervall SL, Marshall AP, Fleser P, Guzman RJ. Association of arterial calcification with chronic limb ischemia in patients with peripheral artery disease. J Vasc Surg. 2018;67:507–13. [DOI] [PubMed] [PMC]

40.

Peng AW, Dardari ZA, Blumenthal RS, Dzaye O, Obisesan OH, Iftekhar Uddin SM, et al. Very high coronary artery calcium (≥1000) and association with cardiovascular disease events, non–cardiovascular disease outcomes, and mortality. Circulation. 2021;143:1571–83. [DOI] [PubMed] [PMC]

41.

De Maria GL, Scarsini R, Banning AP. Management of calcific coronary artery lesions: is it time to change our interventional therapeutic approach? JACC Cardiovasc Interv. 2019;12:1465–78. [DOI] [PubMed]

42.

Abazid RM, Obadah Kattea M, Smettei OA, Beshir Y, Sakr H. Impact of coronary artery calcification on percutaneous coronary intervention and postprocedural complications. J Saudi Heart Assoc. 2017;29:15–22. [DOI] [PubMed] [PMC]