Association of intracranial arterial calcification with residual coronary atherosclerotic burden

Introduction: Intracranial arterial calcification (IAC) is a potential imaging marker of systemic atherosclerosis. This study evaluated the association between the presence of IAC detected on brain computed tomography and the residual coronary atherosclerotic burden after coronary revascularization in patients who underwent elective coronary angiography.Methods: Among patients who underwent elective coronary angiography between January 2022 and December 2022, adults who had a brain computed tomography performed for any reason within six months of the angiography date were retrospectively evaluated. Patients were divided into two groups according to the presence of intracranial arterial calcification on brain CT. Baseline coronary anatomical disease burden was assessed with the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score. The residual SYNTAX score was used as an indicator of the anatomical coronary disease burden remaining after revascularization; a score of 0 was defined as complete anatomical revascularization and a score >0 as the presence of residual coronary disease. The independent association between intracranial arterial calcification and a residual SYNTAX score >0 was assessed by multivariable logistic regression analysis adjusted for age, sex, hypertension, diabetes mellitus, estimated glomerular filtration rate, and baseline SYNTAX score.Results: The 250 patients had a median age of 64 [58–69] years, and 68.8% were men. IAC was present in 189 patients (75.6%). Baseline SYNTAX scores were higher in those with IAC (19.5 [9–27] vs 11 [5–21]; p<0.001). Residual SYNTAX scores were also higher in those with IAC (3 [0–12] vs 0 [0–5]; p<0.001). The proportion with a residual SYNTAX >0 was 57.1% in those with IAC and 32.8% in those without (p<0.001). In the multivariable analysis, IAC was independently associated with residual coronary disease (adjusted odds ratio 2.27; 95% confidence interval 1.15–4.50; p=0.019). The baseline SYNTAX score was also independently associated (adjusted odds ratio 1.026; 95% confidence interval 1.001–1.051; p=0.043) (Tables 1 and 2, Figure 1).Discussion/Conclusion: Intracranial arterial calcification was associated with an increased residual coronary disease burden, independent of baseline coronary anatomical disease burden and major vascular risk factors. These findings suggest that intracranial arterial calcification may be an imaging marker that reflects a more extensive systemic atherosclerotic disease burden.Keywords: