Correlation of Agatston Score With Coronary Artery Calcium Data Reporting System (CAC-DRS), Body Mass Index (BMI) and Body Surface Area (BSA) In Asymptomatic South Indian Patients Using 128-Slice Multi-Slice Computed Tomography (MDCT)

Abstract

Background and Aims: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Coronary artery calcium (CAC) scoring, particularly the Agatston score, serves as a non-invasive biomarker for subclinical atherosclerosis. The CAC Data Reporting System (CAC-DRS) enables standardized risk classification. Body Mass Index (BMI) and Body Surface Area (BSA) are commonly used anthropometric indices; however, their association with coronary calcification remains uncertain. This study aims to evaluate the relationship between CAC scores and anthropometric markers in an asymptomatic South Indian cohort using computed tomography (CT). Methods: This retrospective observational study included 250 asymptomatic adults (162 males, 88 females) aged 20–90 years who underwent CT-based CAC scoring at a tertiary care center. Patients with prior cardiac symptoms or interventions were excluded. BMI and BSA were calculated using standard formulas. Data analysis was performed using SPSS v23.0, employing Spearman’s rank correlation, Kruskal-Wallis test, Pearson Chi-Square, ANOVA, and multivariate logistic regression. Results: The Agatston score showed a strong positive correlation with CAC-DRS (r = 0.885, p < 0.0001). Age correlated moderately with the Agatston score (r = 0.540, p < 0.001). Males had significantly higher CAC scores than females (p = 0.004). In contrast, BMI (r = 0.013, p = 0.842) and BSA (r = 0.067, p = 0.291) had weak, non-significant correlations. Multivariate analysis identified age (p < 0.001) as independent predictors of elevated CAC and male sex (p = 0.001) to have higher scores. Conclusion: While CAC-DRS strongly reflects coronary calcification burden, anthropometric indices like BMI and BSA are poor standalone predictors. These findings underscore the clinical utility of Agatston scoring in cardiovascular risk stratification beyond traditional anthropometric parameters.

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