Altered serum level of cartilage oligomeric matrix protein and its association with coronary calcification in patients with coronary heart disease

Background Cartilage oligomeric matrix protein （COMP） is mainly found in the skeletal system and vascular smooth muscle cells. Recent researches showed that it had a protective function on blood vessels and could also inhibit vascular calcification. We investigated the serum COMPs in coronary heart disease （CHD） patients, and the relationship between serum COMP and the calcification of coronary artery. Methods A total of 233 consecutive chest pain patients who first underwent coronary angiography followed by multi-slice computed to- mography （MSCT） within six months were recruited and divided into two groups according to the coronary angiography luminal diameter narrowing percentages： CHD group （diameter narrowing 〉 50%, n = 194） and control group （diameter narrowing 〈 50%, n = 39）. The Gen- sini score, Syntax score and coronary artery calcium score （CACs） were calculated. The serum COMP level was determined using ELISA. Results The levels of COMP were significantly higher in the CHD group than in the control group 155.7 （124.5-194.5） ng/mL vs. 128.4 （113.0-159.9） ng/mL, P = 0.019. There were no correlation between COMP, Gensini score, Syntax score, severity of coronary stenosis and the number of coronary artery with stenosis 〉 50%. The serum COMP was correlated with age （r = 0.294, P 〈 0.001）, fasting glucose （r = 0.163, P = 0.015）, HbAlc （r = 0.194, P = 0.015） and CACs （r = 0.137, P = 0.037）. Stepwise linear regression analysis showed that COMP level and age were independent predictors of CACs in the CHD patients （fl = 0.402, t = 2.612, P = 0.015; fl = 0.472, t = 3.077, P = 0.005）. Performance of COMP for predicting CHD was shown as area under curve （AUC）： 0.632, 95% CI： 0.549-0.715 and upper tertile CACs was AUC： 0.602, 95% CI： 0.5264）.678 in receiver operating characteristic （ROC） curve analysis. Conclusion Calcification of coronary artery was an independent predictor of serum COMPs.

Myosteatosis is associated with coronary artery calcification in patients with type 2 diabetes

BACKGROUND Myosteatosis,rather than low muscle mass,is the primary etiologic factor of sarcopenia in patients with type 2 diabetes mellitus(T2DM).Myosteatosis may lead to a series of metabolic dysfunctions,such as insulin resistance,systematic inflammation,and oxidative stress,and all these dysfunctions are closely associated with the acceleration of T2DM and atherosclerosis.AIM To investigate the association between myosteatosis and coronary artery calcification(CAC)in patients with T2DM.METHODS Patients with T2DM,who had not experienced major cardiovascular events and had undergone both abdominal and thoracic computed tomography(CT)scans,were included.The mean skeletal muscle attenuation was assessed using abdominal CT images at the L3 level.The CAC score was determined from thoracic CT images using the Agatston scoring method.Myosteatosis was diagnosed according to Martin’s criteria.Severe CAC(SCAC)was defined when the CAC score exceeded 300.Logistic regression and decision tree analyses were performed.RESULTS A total of 652 patients with T2DM were enrolled.Among them,167(25.6%)patients had SCAC.Logistic regression analysis demonstrated that myosteatosis,age,duration of diabetes,cigarette smoking,and alcohol consumption were independent risk factors of SCAC.Myosteatosis was significantly associated with an increased risk of SCAC(OR=2.381,P=0.003).The association between myosteatosis and SCAC was significant in the younger patients(OR=2.672,95%CI:1.477-4.834,P=0.002),but not the older patients(OR=1.456,95%CI:0.863-2.455,P=0.188),and was more prominent in the population with lower risks of atherosclerosis.The decision tree analyses prioritized older age as the primary variable for SCAC.In older patients,cigarette smoking was the main contributing factor for SCAC,while in younger patients,it was myosteatosis.CONCLUSION Myosteatosis is a novel risk factor for atherosclerosis in patients with T2DM,especially in the population with younger ages and fewer traditional risk factors.

Current understanding of coronary artery calcification

Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven- tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD pa- tients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.

Association between serum cartilage oligomeric matrix protein and coronary artery calcification in maintenance hemodialysis patients

Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.

Ideal Cardiovascular Health Metrics and Coronary Artery Calcification in Northern Chinese Population:A Cross-sectional Study

Objective Coronary artery calcification（CAC） is a well-established risk predictor of coronary heart disease events and is recognized as an indicator of subclinical atherosclerosis.Methods A cross-sectional study consisting of 2999 participants aged ≥40 years from the Jidong community of Tangshan City,an industrial and modern city of China,was conducted between 2013 and 2014 to examine the association between the ideal cardiovascular health（CVH） metrics and CAC.The ideal CVH metrics were determined based on the definition of the American Heart Association（AHA）.The participants were then grouped into 4 categories according to the quartiles of their CVH metric scores as follows：first quartile（0-2）,second quartile（3）,third quartile（4）,and fourth quartile（5-7）.CAC was assessed by using high-pitch dual-source CT,and patients were identified based on thresholds of 0,10,100,or 400 Agatston units,as per common practice.Results The prevalence of subclinical atherosclerosis was 15.92%,13.85%,6.76%,and 1.93%,determined by using the CAC scores at thresholds of 0,10,100,and 400 Agatston units,respectively.Compared with the group in the first quartile,the other three CVH groups had a lower odds ratio of CAC 0 after adjusting for age,sex,income level,education level,and alcohol use in the logistic regression analysis.The odds ratios in these groups were 0.86 [95% confidence interval（CI）,0.63-1.17;P0.05],0.75（95% CI,0.55-1.02;P0.05）,and 0.49（95% CI,0.35-0.69;P0.05）,respectively.These associations of CAC with the CVH metrics were consistent when different CAC cutoff scores were used（0,10,100,or 400）.Conclusion The participants with more-ideal cardiovascular metrics had a lower prevalence of subclinical atherosclerosis determined according to CAC score.Maintaining an ideal cardiovascular health may be valuable in the prevention of atherosclerosis in the general population.

Vascular calcification in chronic kidney disease: Pathogenesis and clinical implication

Cardiovascular disease is the leading cause of deathamong patients with chronic kidney disease （CKD）.Vascular calcification （VC） is one of the independentrisk factors associated with cardiovascular disease andcardiovascular mortality in both the general populationand CKD patients. Earlier evidence revealed substan-tially higher prevalence of VC in young adults on chron-ic hemodialysis compared to the general population inthe same age range, indicating the infuence of CKD-related risk factors on the development of VC. Patho-genesis of VC involves an active, highly organized cel-lular transformation of vascular smooth muscle cells tobone forming cells evidenced by the presence of bonematrix proteins in the calcifed arterial wall. VC occursin both the intima and the media of arterial wall withmedial calcification being more prevalent in CKD. Inaddition to traditional cardiovascular risks, risk factorsspecific to CKD such as phosphate retention, excessof calcium, history of dialysis, active vitamin D therapy in high doses and deficiency of calcification inhibitors play important roles in promoting the development of VC. Non-contrast multi-slice computed tomography has often been used to detect coronary artery calcif-cation. Simple plain radiographs of the lateral lumbar spine and pelvis can also detect VC in the abdominal aorta and femoral and iliac arteries. Currently, there is no specifc therapy to reverse VC. Reduction of calcium load, lowering phosphate retention using non-calcium containing phosphate binders, and moderate doses of active vitamin D may attenuate progression. Parenteral sodium thiosulfate has also been shown to delay VC progression.

Role of different imaging modalities of vascular calcification in predicting outcomes in chronic kidney disease

Vascular calcification(VC) is common among patientswith chronic kidney disease(CKD).The severity of VC is associated with increased risk of cardiovascular events and mortality.Risk factors for VC include traditional cardiovascular risk factors as well as CKD-related risk factors such as increased calcium and phosphate load.VC is observed in arteries of all sizes from small arterioles to aorta,both in the intima and the media of arterial wall.Several imaging techniques have been utilized in the evaluation of the extent and the severity of VC.Plain radiographs are simple and readily available but with the limitation of decreased sensitivity and subjective and semi-quantitative quantification methods.Mammography,especially useful among women,offers a unique way to study breast arterial calcification,which is largely a medial-type calcification.Ultrasonography is suitable for calcification in superficial arteries.Analyses of wall thickness and lumen size are also possible.Computed tomography(CT) scan,the gold standard,is the most sensitive technique for evaluation of VC.CT scan of coronary artery calcification is not only useful for cardiovascular risk stratification but also offers an accurate and an objective analysis of the severity and progression.

Impact of main vessel calcification on procedural and clinical outcomes of bifurcation lesion undergoing provisional single-stenting intervention: a multicenter, prospective, observational study

Background Few data on the combined effects of bifurcation and calcification on coronary artery disease(CAD)patients undergoing percutaneous coronary intervention(PCI)are available.This study evaluated the impact of main vessel(MV)calcification on the procedural and long-term outcomes in patients with CAD who underwent provisional single stent PCI.Methods This is a multicenter,prospective,observational study.Patients with bifurcation lesions were enrolled at 10 PCI centers in China from January 2015 to December 2017.Intravascular ultrasound or optical coherence tomography was performed in all patients to evaluate the MV calcification.Patients were treated with provisional single stent strategy using drug eluting stents and followed-up at 1 month,6 months and 12 months after discharge by telephone contact or outpatient visit.Repeated coronary imaging was performed within one year.We compared the procedural success rates in MV and in side branch(SB),and target lesion failure(TLF),defined as a composite of cardiac death,non-fatal myocardial infarction,definite or possible stent thrombosis and target lesion revascularization between patients with and without MV calcification.Results A total of 185 subjects were enrolled according to the inclusion and exclusion criteria of this study.MV calcification was detected in 119(64.3%,calcification group)and not found in 66(35.7%,non-calcification group)patients.The angiographic success rate of MV was 95.8%in the calcification group and 97.0%in the non-calcification group(P=0.91);the angiographic success rate of SB was 32.8%in the calcification group and 53.0%in the non-calcification group(P<0.05).During the one-year follow-up period,TLF occurred in 14(11.8%)patients in the calcification group and in 13(19.7%)in the non-calcification group{P=0.31).Multivariate regression analysis showed the same result(HR=1.23,95%CI:0.76-1.52,P=0.47).Calcification on group had higher recurrent angina than non-calcification group(13.51%vs.17.65%,P<0.05).Conclusions In patients with coronary bifurcation lesion treated with provisional one stent approach,calcification of MV is associated with lower SB procedural success rate,it could increase recurrence of angina;however,it was not associated with an increased risk of TLF.

Coronary artery disease in Chinese adults with type 2 diabetes mellitus estimated by electron beam computed tomography and electron beam computed tomography angiography

Objective To assess the prevalence and risk of coronary artery disease(CAD)in Chinese adults with type 2 diabetes mellitus(T2DM)using electron beam computed tomography(EBCT)and EBCT angiography(EBCTA).Methods:Ninety-four cases were enrolled in this study including diabetes(n=28),impaired glucose tolerance(IGT,n=30),coronary heart disease(CHD,n=11),and control(n=25).Cardiac EBCT plain scanning and EBCTA were performed on all of these subjects to evaluate coronary artery calcifica-tion(CAC)scores,and number of segments of stenosed coronary arteries.Both CAC and/or coronary artery stenosis were defined as patients with coronary artery lesions(CAL).Results CAC scores were not different with the control,diabetes,IGT,or CHD(P>0.05)groups.Compared to control(0.520±1.295),more stenosed coronary arteries segments(P<0.05)were detected in diabetes(2.964±1.915),IGT(2.200±2.024),and CHD(2.273±1.679).Number of stenosed artery segments were correlated with age(r=0.215,P=0.019),postprandial glucose(r=0.224,P=0.015),total cholesterol(r=0.323,P=0.000),and duration of diabetes(r=0.208,P=0.004).The incidences of CAL in diabetes(96.43%),IGT(93.33%),and CHD(90.91%)was substantially higher than that in normal control(56.00%,P<0.01).The odds ratio of CAL associated with having diabetes was estimated to be 7.514(95%CI:1.885-63.778).Conclusions Coronary artery lesions are prevalent in Chinese adults with type 2 diabetes,implying a high CAD risk.EBCTA holds potential in depicting the details of CAL and can be used to track the progression of CAD in diabetes patients.

Calcific aorta and coronary artery： two cases of calcific ascending aorta and descending aorta

Calcific aorta is a disease of old age and is an independent risk factor for morbidity and mortality. Here, we present two patients with calcific aorta at different levels. One with a descending porcelain aorta, and modified Bentall＇s procedure was done. Second is a patient who is having a calcific ascending aorta and coronary artery. Coronary artery bypass grafting from left internal mammary artery to left anterior descending was done for the patient. The calcification and its morbidity had been discussed briefly.

Intravascular lithotripsy for coronary calcium:A case report and review of the literature

BACKGROUND Coronary calcium poses a challenge for the interventional cardiologist often leading to stent under-expansion and subsequent ischemic events.Aggressive balloon post-dilatation though helpful is usually inadequate.Multiple plaque ablation techniques are in vogue,but they are technically demanding and are not without complications.Shockwave intravascular lithotripsy(S-IVL)has emerged as a user-friendly and effective mechanism for calcium management with a high safety margin.A series of trials(DISRUPT CAD I-IV)have demonstrated both short-term and long-term safety and efficacy of the technique.As experience with the technique grows more and more,therapy areas like stent restenosis are being covered by the S-IVL.CASE SUMMARY We report a series of 2 cases successfully managed with S-IVL therapy at our center.The first case is of a 57-year-old smoker who presented with acute coronary syndrome.His left anterior descending coronary artery revealed calcified 90%stenosis on angiogram and a combination of superficial-deep calcium on intracoronary imaging.The calcium was treated with 20 pulses of S-IVL to create discontinuity and a sirolimus eluting drug-eluting stent was successfully implanted.The second case is that of an elderly lady who presented with stable angina and demonstrated diffuse calcified lesions in the left anterior descending artery on angiogram.She also demonstrated a mixture of superficial and deep seated calcium zones on imaging.S-IVL therapy was applied to generate fractures in calcium,and two overlapping drug-eluting stents were implanted successfully without any complications.CONCLUSION S-IVL is an emerging,efficient,user-friendly and safe therapy for managing intracoronary calcium in routine interventional practice.

Research Progress on the Relationship between Coronary Artery Calcification and Chronic Renal Failure

Objective： Coronary artery calcification （CAC） is thought to be a controlled metabolic process that is very similar to the formation of new bone. In patients with chronic renal failure （CRF）, CAC is very common, and CAC severity correlates with the deterioration of renal lilnction. We summarized the current understanding and emerging findings of the relationship between CAC and CRF. Data Sources： All studies were identified by systematically searching PubMed, Embase, and CNKI databases for the terms ＂coronary calcification＂, ＂＇chronic renal failure＂, ＇~vascular smooth muscle cell＂, and their synonyms until September 2017. Study Selection： We examined the titles and abstracts of all studies that met our search strategy thoroughly. The full text of relevant studies was evaluated. Reference lists of retrieved articles were also scrutinized for the additional relevant studies. Results： CRF can accelerate CAC progression. CRF increases the expression of pro-inflamrnatory factors, electrolyte imbalance （e.g., of calcium, phosphorus）, parathyroid hon^none, and uremic toxins and their ability to promote calcification. These factors, through the relevant signaling pathways, trigger vascular smooth muscle cells to transtbrm into osteoblast-like cells while inhibiting the reduction of vascular calcification factors, thus inducing further CAC. Conclusions： Coronary heart disease in patients with CRF is due to multiple factors. Understanding the mechanism of CAC can help interventionists to protect the myocardium and reduce the prevalence of coronary heart disease and mortality.

Aggressive plaque modification with rotational atherectomy and cutting balloon for optimal stent expansion in calcified lesions

Objective To evaluate the factors affecting optimal stentt expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy （RA） and a cutting balloon （CB）. Methods From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital （Beijing, China） were included in this study, They were divided into a rotational artherectomy combined with cutting balloon （RACB） group （46 patients treated with RA followed by CB angioplasty） and an RA group （46 patients treated with RA followed by plain balloon angioplasty）. Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty （POBA） were de- mographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque prepara- tion. Lumen diameter and lumen diameter stenosis （LDS） were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS 〈 10%. Results The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group （from 54.5% ± 8.9% to 36.1%＋ 7.1%） but only moderately decreased （from 55.7% ± 7.8% to 46.9% ± 9.4%） in the RA group （time × group, P 〈 0.001）. After stenting, there was a higher rate of optimal stent expansion in the RACB group （71.7% in the RACB group, 54.5% in the RA group, and 15% in the POBA group, P 〈 0.001）, and the final LDS was significantly diminished in the RACB group compared to the other two groups （6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, P 〈 0.001）. Moreover, an LDS 〈 40% after plaque preparation （OR = 2.994, 95% CI： 1.297-6.911） was associated with optimal stent expansion, which also had a positive correlation with the appearance of a calcified ring split （r = 0,581, P 〈 0.001）. Conclusions Aggressive plaque modification with RA and CB achieve more optimal stent expansion. An LDS ≤ 40% after plaque modification was a predictive factor for optimal stent expansion in calcified lesions. This parameter was also associated with the presence of calcified ring split.

Metabolic syndrome and coronary artery calcification： a community-based natural population study

Background Little is known about the influence of metabolic syndrome （MetS） on coronary artery calcification （CAC） in China. In this article, we aimed to explore the distribution of CAC in populations with and without MetS, and estimate the influence of MetS and its components on CAC in a community-based population of Beijing. Methods A total of 1647 local residents of Beijing, age 40-77 years, were recruited for a cardiovascular risk factors survey and were determined fasting plasma glucose （FPG）, blood lipids, and 64 multi-detector computed tomography （64-MDCT） coronary artery calcium score （CACS） measurement （Agatston scoring）. The distribution of CAC was described, and the influence of MetS components on CAC was evaluated. Results In this population, the prevalence and extent of CAC increased with increasing age and both were higher in MetS subjects compared to nonMetS subjects （all P 〈0.05）, with the exception of those older than 65 years old. The risk of CAC increased with increasing numbers of MetS components, and the odds ratios for predicting positive CAC in subjects with 1, 2, 3, and 〉4 MetS components were 1.60, 1.84, 2.12, and 3.12, respectively （all P 〈0.05）. Elevated blood pressure, elevated FPG, elevated triglycerides, and overweight increased the risk of CAC, yielding odds ratios of 2.64, 1.67, 1.32, and 1.37, respectively （all P 〈0.05）. Conclusions In the Beijing community-based population, MetS increases the risk of CAC. The risk of CAC increases with increasing numbers of MetS components. Not only the number, but also the variety of risk factors for MetS is correlated with the risk of CAC. Elevated blood pressure, hyperglycemia, hypertriglyceridemia and overweight increase the risk of CAC.

Coronary artery calcification is associated with atherogenic lipid changes, cardiac dysfunction and morphologic abnormalities in HIV-1 infected black adults

The heart is an organ frequently affected in the acquired immunodeficiency syndrome.~1 But there is little information as to whether the coronary artery calcification can identify asymptomatic individuals at high risk for having cardiac morphological and functional abnormalities and cardiac risk factors in human immunodeficiency virus (HIV)-infected persons. Accordingly, the purpose of this study was to determine whether coronary artery calcification was associated with cardiac morphological and functional abnormalities, atherogenic lipid and C-reactive protein (CRP) changes in a black adult population with HIV-1 infection.

Oxidized phospholipids and lipoprotein-associated phospholipase A_2 as important determinants of Lp(a) functionality and pathophysiological role

Lipoprotein（a） [Lp（a）] is composed of a low density lipoprotein（LDL）-like particle to which apolipoprotein（a）[apo（a）] is linked by a single disulfide bridge. Lp（a） is considered a causal risk factor for ischemic cardiovascular disease（CVD） and calcific aortic valve stenosis（CAVS）. The evidence for a causal role of Lp（a） in CVD and CAVS is based on data from large epidemiological databases, mendelian randomization studies, and genome-wide association studies. Despite the well-established role of Lp（a） as a causal risk factor for CVD and CAVS, the underlying mechanisms are not well understood. A key role in the Lp（a） functionality may be played by its oxidized phospholipids（OxPL） content. Importantly, most of circulating OxPL are associated with Lp（a）; however, the underlying mechanisms leading to this preferential sequestration of OxPL on Lp（a） over the other lipoproteins,are mostly unknown. Several studies support the hypothesis that the risk of Lp（a） is primarily driven by its OxPL content.An important role in Lp（a） functionality may be played by the lipoprotein-associated phospholipase A_2（Lp-PLA_2）,an enzyme that catalyzes the degradation of OxPL and is bound to plasma lipoproteins including Lp（a）. The present review article discusses new data on the pathophysiological role of Lp（a） and particularly focuses on the functional role of OxPL and Lp-PLA_2 associated with Lp（a）.

Prognostic Value of Gai＇s Plaque Score and Agatston Coronary Artery Calcium Score for Functionally Significant Coronary Artery Stenosis

Background： The prognostic valtles of the coronary computed tornography angiography （CCTA） score for predicting future cardiovascular events have been previously demonstrated in numerous studies. However, few studies have used the rich information available from CCTA to detect functionally significant coronary lesions. We sought to compare the prognostic values of Gai＇s plaque score and the coronary artery calcium score tCACS） of CCTA for predicting functionally significant coronary lesions, using fractional flow reserve （FFR） as the gold standard. Methods： We retrospectively analyzed 107 visually assessed significant coronary lesions in 88 patients （mean age, 59.6 ± 10.2 years： 76.14% of males） wino underwent CCTA, invasive coronary angiography, and invasive FFR nneasurement. An FFR 〈0.80 indicated hemodynamically significant coronary stenosis. Lesions were divided into two groups using an FFR cutoffvalue of 0.80. We compared Gai＇s plaque scores and CACS between the two groups and evaluated the correlations of these scores with FFR. The statistical methods included unpaired t-test, Mann-Whitney U-test, and Spearman＇s correlation coefficients. Results： Coronary lesions with FFR 〈0.80 lind Inigtner Gai＇s scores than those with FFR 〉0.80. Gai＇s score had the strongest correlation with FFR （r= 0.48, P 〈 0.01 ） and lind a greater area under tlne curve 0.72 （95% confidence interval： 0.61 0.82： P 〈 0.01 ） than the CACS of whole arteries and a single artery. Conelusions： Botin CACS in a single artery and Gai＇s plaque score demonstrated a good capacity to assess functionally significant coronary artery stenosis when compared to the gold standard FFR. However, Gai＇s plaque score was more predictive of FFR 〈0.80. Gai＇s score cain be easily calculated in daily clinical practice and could be used when considering revascularization.