Correlation of Coronary Artery Calcium Score with Vessel-Specific Stenosis & Plaque Burden

Abstract

Introduction: Coronary artery calcium scoring (CACS) quantifies calcified atherosclerotic burden, whereas coronary CT angiography (CCTA) directly evaluates coronary lumen, stenosis and plaque extent. Because coronary atherosclerosis is heterogeneous across individual vessels, vessel-wise comparison of calcium burden with CCTA-defined stenosis and CAD-RADS plaque burden may provide a more clinically meaningful assessment than total calcium score alone.

Aim & Objective: To evaluate the vessel-wise distribution of coronary artery calcium, compare it with vessel-specific stenosis on CCTA, and assess the relationship of calcium burden and stenosis severity with CAD-RADS plaque burden categories in clinically suspected coronary artery disease patients.

Material & Methods: This prospective observational study included 196 clinically suspected CAD patients evaluated in the Department of Radio-Diagnosis, Maharani Laxmi Bai Medical College, Jhansi, from March 2025 to February 2026. All participants underwent non-contrast ECG-gated calcium scoring followed by CCTA. Agatston scores and stenosis severity were assessed for the LMA, LAD, LCX, RCA and PDA, and CCTA plaque burden was categorized as P1, P2 or P3.

Results: CAC was most frequently detected in the RCA (73.5%), followed by the LAD (59.7%), LMA (47.4%), LCX (33.2%) and PDA (13.3%); mean vessel-specific CAC was highest in the RCA (25.6 ± 46.6) and LAD (25.3 ± 42.8). On CCTA, any stenosis was present in all LAD and RCA assessments, and the RCA had the highest mean stenosis (41.6 ± 25.3%). Severe stenosis occurred in 23.5% of LMA and 19.4% of RCA assessments. P1, P2 and P3 plaque burden accounted for 51.5%, 16.8% and 31.6% of patients. Mean total CAC was markedly higher in P2 (148.7 ± 115.8) and P3 (140.5 ± 174.7) than in P1 (19.2 ± 21.3), while severe stenosis occurred in 22.8%, 51.5% and 53.2%, respectively.

Conclusion: Coronary calcium and stenotic burden showed marked vessel-wise heterogeneity, with the greatest calcium and luminal disease concentrated in the RCA and LAD. Higher CAD-RADS plaque burden categories were accompanied by substantially greater calcium burden than P1 and a higher frequency of severe stenosis. CACS therefore provides useful information on calcified disease extent, but CCTA remains essential for defining vessel-specific luminal narrowing and overall plaque burden.

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