The predictive value of computed tomography calcium scores: a comparison with quantitative volumetric intravascular ultrasound

ObjectiveTo evaluate the relationship between coronary artery calcium scoring (CACS) and intravascular ultrasound (IVUS) calcification and disease severity.MethodsForty-five angina patients who underwent CACS 18±23 days before IVUS were studied. The CACS was recorded for each lesion matched to a specific IVUS lesion. Cross-sectional area measurements of the external elastic membrane, lumen area, plaque and media, and plaque burden were performed. The arc and length of calcification were measured.ResultsThere were 106 calcified lesions detected by IVUS. Eighty-five of those lesions (80%) were detected by CACS, but 21 calcified lesions (20%) were missed. Fourteen (50%) out of 28 of the lesions with an IVUS-calcium arc below the 25th percentile (51.4°) were detected by CACS vs. 91% of lesions with an IVUS-calcium arc >51.4° (P<.05). Similarly, 21 (58%) of 36 lesions ≤3 mm in length were detected vs. 91% of lesions >3 mm (P<.05). We divided IVUS-calcified lesions into CACS ≤10 and >10. Mean plaque burden, calcified length, and arc of calcium increased significantly, while minimum lumen area decreased with increasing CACS. There was the same tendency in culprit and nonculprit calcified lesions, respectively. Multivariate analysis showed a calcified length (regression coefficient=8.718, 95% CI 4.668–12.77, P<.001) and an arc of calcium (regression coefficient=2.789, 95% CI 1.419–4.119, P<.001) were significant predictors for CACS.ConclusionsThis study suggests that a CACS could evaluate coronary calcium burden noninvasively through the accurate estimation of calcium-arc and length.