TOPLINE

A simplified non-zero-calcification-risk Multi-Ethnic Study of Atherosclerosis (nzcr-MESA) score correlated moderately with the extent of coronary artery calcification (CAC) and the severity of coronary artery stenosis on coronary CT angiography (CCTA), offering a practical tool to preselect appropriate cardiac imaging protocols, a retrospective study found.

METHODOLOGY

• Researchers retrospectively evaluated 241 Caucasian patients with suspected coronary artery disease (CAD) who underwent CCTA at a German university hospital between January and August 2024.
• All participants were scanned using a first-generation dual-source photon-counting CT system with an unenhanced coronary calcium scoring scan, followed by contrast-enhanced ECG-gated CCTA or ultra-high-resolution (UHR) CCTA to determine the extent of coronary artery stenosis.
• The objective extent of CAC was quantified using Agatston scores and classified as no calcification (score, 0), mild (score, 1-100), moderate (score, 101-399), or severe (score ≥ 400), and the severity of coronary artery stenosis was categorised using the CAD-Reporting and Data System (CAD-RADS) 2.0.
• Investigators calculated nzcr-MESA scores on the basis of patient age, sex, and ethnicity and compared them to the extent of calcification.
• Area under the receiver operating characteristic curve analysis was performed to assess the ability of nzcr-MESA scores in distinguishing patients with severe CAC from those with none, mild, or moderate CAC.

TAKEAWAY

• The nzcr-MESA scores correlated moderately with Agatston CAC for women (correlation coefficient [R], 0.56) and men (R, 0.39) and with CAD-RADS disease severity scores for women (R, 0.45) and men (R, 0.42; P < .0001 for all).
• Mean nzcr-MESA scores increased with CAD-RADS disease severity scores, measuring 38.7% for a CAD-RADS score of 0, 61.5% for a CAD-RADS score of 1-2, and 73.3% for a CAD-RADS score ≥ 3.
• The optimal cutoff for nzcr-MESA was identified at 90% for women, 95% for men, and 95% for the combined cohort. A 90% cutoff across both sexes would have correctly routed 73% of patients to an appropriate protocol; 24% would have been unnecessarily sent to a UHR scanner; only 3% would have been falsely denied a needed UHR scan.
• Analysis of the nzcr-MESA score revealed a moderate discriminative ability in identifying severe CAC (area under the curve, 0.74 for women; 0.66 for men; and 0.72 for the entire cohort; P < .01 for all).

IN PRACTICE

"The nzcr-MESA score may primarily help identifying patients who likely do not warrant a UHR scan," the authors wrote.

"The nzcr-MESA score offers a practical, easy-to-implement tool for predicting CAC in routine clinical practice which in turn may aid to preselect patients for the appropriate CCTA protocol, and potentially optimizing both workflow efficiency and patient safety," they added.

SOURCE

The study was led by Alexander M.C. Böhner, University Hospital Bonn, Bonn, Germany. It was published online on July 17, 2026, in the European Journal of Radiology.

LIMITATIONS

The study was limited by its exclusive inclusion of Caucasian individuals, which may have restricted generalisability to other ethnic populations. The single-centre design with a single CT scanner further limited broader applicability. The cohort consisted of patients referred by cardiologists with suspected diagnoses rather than asymptomatic individuals, potentially introducing a selection bias. Additionally, the study included more men than women, and men had a higher average CAC burden, which may have affected the broader applicability of the findings.

DISCLOSURES

No funding information was provided for this study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.