Relationship Between Baseline Coronary Calcium Score and Demonstration of Coronary Artery Stenoses During Follow-Up MESA (Multi-Ethnic Study of Atherosclerosis)

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. 

PMID: 19833306

Posted in Computed Tomography and tagged , , .


  1. Indeed, zero calcium score does not exclude significant stenosis in symptomatic patients, especially in ACS. Low calcium score may also be associated with even higher prevalence of obstructive CAD.
    See Also:
    Prevalence and extent of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrome.
    Rubinshtein R, Gaspar T, Halon DA, Goldstein J, Peled N, Lewis BS.
    Am J Cardiol. 2007 Feb 15;99(4):472-5.

  2. Bottom line: A calcium score of zero should not dissuade from considering patients with acute chest pain as acute coronary cases.

    The MESA study continues to provide important data on atherosclerosis. One very interesting conclusion is that per-vessel; the extent of coronary calcification was related to the degree of coronary stenosis. It would’ve definitely be interesting if the MESA patients had had CT angiographies performed as well (maybe some did?) to correlate the extent of soft plaque – which in theory would be higher – and compare with other patients with similar calcium scores but no symptoms.

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