Calcium Distribution Patterns of the Aorta as Predictors of Significant Coronary Artery Disease in Patients with Moderate to Severe Aortic Stenosis

OBJECTIVE Computed tomography (CT) of the aortic valve and aorta has gained a greater role in planning for aortic valve replacement (AVR). However, when AVR is planned, invasive coronary angiography remains the standard investigation. Whether the calcium distribution pattern in the aorta predicts the significant presence of coronary artery disease (CAD) in patients undergoing AVR remains unclear. This study evaluated the correlation between the calcium distribution pattern from the CT aorta to predict significant CAD in patients with symptomatic moderate to severe aortic stenosis undergoing AVR. METHODS This retrospective study included candidates for AVR either with transcatheter replacement (TAVR) or surgical replacement (SAVR) at a single tertiary-care center between 2017 and 2022. The calcium distribution patterns from the left ventricular outflow tract up to the descending aorta were analyzed from the non-contrast CT of the aorta. Significant CAD was identified from invasive coronary angiography and was defined as 50% diameter stenosis (DS) of the left main and 70% DS of the proximal left anterior descending artery. Multivariate logistic regression analysis was performed to