Does the coronary artery calcium score continue to hold prognostic significance in both acute and chronic coronary syndromes?

Abstract Background With the introduction of Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0 scoring system for interpreting coronary CT angiography, the routine use of calcium scoring methods such as the Agatston score and the Coronary Artery Calcium Data and Reporting System (CAC-DRS) has become less prevalent. Purpose The purpose of this study is to determine whether Agatstone score and CAC-DRS score retains their prognostic relevance in the assessment of acute and chronic coronary syndromes. Materials and methods A total of 779 patients were retrospectively identified through electronic medical records between July 2022 and June 2023. Data collected included coronary artery disease risk factors, such as diabetes mellitus, hypertension, smoking habits, dyslipidemia, and family history, along with calcium scores using the Agatston method and CAC-DRS, as well as the CAD-RADS 2.0 classification. Bivariate and multivariate analyses were carried out with SPSS version 26.0, and Kaplan-Meier curves were employed to assess the prognostic impact of the CAC-DRS. Results The median age was 65 years among the 779 patients evaluated. Over a median follow-up period of 30 months, 251 patients developed stable angina pectoris (AP), while 82 experienced acute coronary syndrome (ACS). Bivariate analysis revealed that Agatstone score (p = 0.0000), the CAC-DRS score (p = 0.000) and CAD-RADS 2.0 classification (p = 0.000) were significantly associated with the occurrence of AP and ACS compared to non-occurrence. Multivariate analysis further demonstrated that higher CAC-DRS categories (p = 0.000) and CAD-RADS 2.0 categories (p = 0.000) were significantly associated with AP. Similarly, higher CAC-DRS categories (p = 0.001) and CAD-RADS 2.0 categories (p = 0.000) were significantly associated with ACS. Additional covariates such as smoking history, previous history of coronary heart disease, and body mass index (BMI) category were also significantly associated with the incidence of AP and ACS. Kaplan-Meier survival analysis demonstrated an increasing hazard for both AP and ACS with higher CAC-DRS category levels. Conclusion The Agatstone score and CAC-DRS score remains a significant prognostic indicator for predicting both angina pectoris and acute coronary syndrome.