Coronary Artery Calcium Score and Carotid Intima-Media Thickness As Markers of Computed Tomography Angiographic Severity in Coronary Artery Disease: A Cross-Sectional Study

Introduction: Coronary Artery Calcium Score (CACS) and Carotid Intima-Media Thickness (CIMT) are widely accepted non-invasive indicators of subclinical atherosclerotic burden. Although their prognostic value for predicting cardiovascular events is well established, data linking these markers to the anatomical complexity of coronary artery disease (CAD) - particularly when assessed with computed tomography (CT) derived Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) and Gensini scoring systems - remain sparse. This study was designed to quantify the relationship between CACS, CIMT and the CT angiographic severity of CAD. Methods: A cross-sectional study enrolling 75 symptomatic patients referred for CT coronary angiography (CTCA) was conducted over a period of 24 months at a single tertiary centre. CACS was quantified by the Agatston method on non-contrast electrocardiogram-gated CT. CIMT was assessed bilaterally with high-resolution B-mode ultrasonography following the Mannheim consensus. Disease severity was graded using CT-adapted SYNTAX and Gensini scores. Statistical analysis included Pearson's correlation, one-way ANOVA, and chi-square testing (p < 0.05 considered significant). Results: The cohort comprised 75 patients (mean age 58.84 ± 9.75 years; 62.7% male). Mean CACS was 291.15 ± 164.46 Agatston units and mean CIMT was 0.82 ± 0.18 mm. CACS demonstrated a very strong positive correlation with SYNTAX score (r = 0.813; p < 0.001) and Gensini score (r = 0.851; p < 0.001). CIMT showed a moderate-to-strong positive correlation with SYNTAX score (r = 0.583; p < 0.001) and a strong positive correlation with Gensini score (r = 0.694; p < 0.001). Both CACS and CIMT were significantly associated with severity of coronary artery disease. Conclusion: CACS and CIMT correlate significantly with CT-derived measures of coronary disease severity, underscoring their complementary roles in non-invasive cardiovascular risk stratification. Combined assessment of these markers may improve patient selection for advanced imaging and individualise preventive management.