The correlation between serum calcium levels and angiographic severity of coronary artery disease in patients with acute coronary syndrome
DOI:
https://doi.org/10.59736/IJP.24.03.1120Keywords:
Acute Coronary Syndrome, Coronary Artery Disease, Coronary Angiography, Serum Calcium, SYNTAX ScoreAbstract
Background: Acute coronary syndrome (ACS) is one of the frequent illnesses and causes of mortality worldwide. An easy identifier can assist the physicians to identify a patient with more severe coronary artery disease. This has been investigated using serum calcium, although its correlation with severity observed during angiography remains unclear. This investigation was done to assess the association between serum calcium and the severity of coronary artery disease, determined with the SYNTAX score, among patients with ACS.
Methods: We undertook a cross-section study in Cardiology Department of Ayub Teaching Hospital, Abbottabad. Non-probability consecutive sampling was used to include 105 patients that had ACS. Coronary disease severity was determined by SYNTAX and serum calcium was measured. Data analysis was done on SPSS, and p value of 0.05 was regarded as being statistically significant.
Results: The research entailed 105 patients. Their mean age was 58.94 ± 8.64 years; 70 (66.7%) were men and 35 (33.3%) were women. Mean serum calcium was 8.49 ± 0.44 mg/dL and mean SYNTAX score was 22.22 ± 6.67. The low, intermediate, and high SYNTAX groups included 55 (52.4%), 42 (40.0%), and 8 (7.6%) patients, respectively. Between a lower SYNTAX score and a lower serum calcium level (p<0.001) a correlation was established between them. The correlation of Pearson indicated that there was a moderate negative relationship between serum calcium and SYNTAX score (r = -0.658, p<0.001).
Conclusion: In patients with ACS, continuous lower serum calcium levels led to more severe coronary artery disease on the angiography. The simple and inexpensive serum calcium could be an extra marker that will help derive more data on disease severity.
References
Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart Disease and Stroke Statistics-2021 Update: A Report from the American Heart Association. Circulation. 2021;143(8):e254-e743. doi:10.1161/CIR.0000000000000950
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. EurHeartJ.2021;42(14):1289-367. doi:10.1093/eurheartj/ehaa575
Zhao D, Liu J, Wang M, Zhang X, Zhou M. Epidemiology of cardiovascular disease in China: current features and implications. Nat Rev Cardiol. 2019;16(4):203-12. doi:10.1038/s41569-018-0119-4
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: A Report from the American HeartAssociation.Circulation.2019;139(10): e56e528.
doi:10.1161/CIR.0000000000000659
Papazoglou AS, Farmakis IT, Zafeiropoulos S, Moysidis DV, Karagiannidis E, Stalikas N, et al. Angiographic severity in acute coronary syndrome patients with and without standard modifiable risk factors. Front CardiovascMed.2022;9:934946. doi:10.3389/fcvm.2022.934946
Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219-27. doi:10.4244/EIJV1I2A35
Sharma A. Association of Hs-CRP levels in patients with acute coronary syndromes and it’s correlation with angiographic severity of coronary artery stenosis. Indian J Cardiovasc Dis Women. 2023;8(1):37-42. doi:10.1055/s-0043-1768589
Prakash VR, Shariff MO, Prakash VS. Correlation of glycemic status with angiographic severity of coronary artery disease in acute coronary syndrome. J Assoc Physicians India.2025;73(8):61. doi:10.5005/japi-11001-0428
Jha A, Tiwari BC, Upadhyay AC, Vijay SK, Jamwal N, Singh AK, et al. Serum Heavy Metal Burden and Its Association with Angiographic Severity and Six-Month Outcomes in Coronary Artery Disease: A Prospective Observational Study From North India. Cureus. 2025;17(10): e95177. doi:10.7759/cureus.95177
Azam MH, Danish N, Wahab MA, ur Rehman A, Naeem S, Muhammad SK. The Relationship between Serum Calcium Levels and Angiographic Severity of Coronary Artery Disease in Patients with Chronic Coronary Syndrome. Pak Heart J. 2024;57(3):194-200. doi:10.47144/phj.v57i3.2678
Wang H, Li J, Tian J. Correlation between serum calcium and cardiovascular outcome among patients suffering from acute coronary syndrome. Iran Red Crescent Med J. 2021;23(2): e676. doi:10.32592/ircmj.2021.23.2.676.
Wang R, Tian J. Correlation between serum calcium and cardiovascular outcome in patients with acute coronary syndrome. J Capital Med Univ. 2023;44(1):154. doi: 10.3969/j.issn.1002-1922.2023.01.021.
Noshin TF, Ali MR, Banik S. Increased oxidative stress and altered serum macro-minerals and trace elements levels are associated with coronary artery disease. J Trace Elem Med Biol.2021; 64:126707. doi: 10.1016/j.jtemb.2020.126707
Park B, Lee YJ. Borderline high serum calcium levels are associated with arterial stiffness and 10‐year cardiovascular disease risk determined by Framingham risk score. J Clin Hypertens (Greenwich) 2019;21(5):668-73. doi:10.1111/jch.13540
Tibaut M, Caprnda M, Kubatka P, Sinkovič A, Valentova V, Filipova S, et al. Markers of atherosclerosis: part 1–serological markers. Heart Lung Circ 2019;28(5):667-77. doi: 10.1016/j.hlc.2018.01.009
Zhang C, Bangming C, Huang X, Jian G, Ming X, Xiangjun Y, et al. Association between serum calcium and first incident acute myocardial infarction: a cross-sectional study.IranJPublic Health2020;49(7):1278.
doi:10.18502/ijph. v49i7.3580
Ismail A, Abdeltawab A, Roshdy A. Echo-cardiography calcium score as predictive tools of severity of coronary arterydisease.QJM2021;114(Supplement1)doi:10.1093/qjmed/hcab090.011
Pathakota SR, Durgaprasad R, Velam V, Ay L, Kasala L. Correlation of coronary artery calcium score and carotid artery intima-media thickness with severity of coronary artery disease. J Cardiovasc ThoracRes.2020;12(2):78. doi:10.34172/jcvtr.2020.14
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