The Association of Costal Cartilage Calcification and Endothelial Activation and Stress Index with the Presence and Severity of Coronary Artery Disease in Patients Scheduled for Cardiac Surgery

Various markers and indicators have been examined to reveal the presence and complexity of coronary artery disease (CAD). One of these biomarkers that has been the subject of research in cardiovascular diseases recently is the Endothelial Activation and Stress Index (EASIX) value. Calcification of costal cartilage (CCC) is one of the indicators of tissue calcification and can show different characteristics according to age and gender. In the present study, we investigated the significance of CCC and EASIX values in demonstrating the presence and complexity of CAD. Consecutive patients scheduled for cardiac surgery between 10 January 2025 and 15 June 2026 were included retrospectively. Firstly, patients were divided into two groups: those without CAD and those with CAD. To further assess the data distributions, patients were first split into two groups based on their SYNTAX scores. The control group consisted of 206 patients with a median age of 53 (18–87), while the CAD patient group consisted of 550 patients with a median age of 62 (30–86) (p < 0.001). Subsequently, 550 CAD patients were divided into groups according to the severity of coronary artery disease. Multivariable logistic regression analyses were performed to identify factors playing a role in demonstrating the presence or severity of coronary artery disease. Advanced age, hypertension, smoking, presence of carotid artery disease, high HbA1c values, and CCC volume were associated with CAD. Also, high HbA1c, a high EASIX value, and CCC volume were associated with complex CAD. The current study has shown that the CCC evaluation in these CT images may help to raise suspicion of CAD, thus favoring early diagnosis. Furthermore, our analyses have shown that we may raise suspicion of complex CAD using the EASIX value and CCC evaluation.