BackgroundAortic valve sclerosis (AVS) and mitral annular calcification (MAC) are considered asmanifestations of generalized atherosclerosis. Few data are available about them in clinicallymanifested coronary artery disease (CAD). Their use as a useful indicator of the angiographicpresence and severity of CAD in patients 65 years has not yet been elucidated.ObjectiveThe purpose of this study was to evaluate the association between different forms of cardiaccalcifications namely; Aortic valve calcification (AVC), MAC, aortic (arch and descending) andcoronary calcifications, and the presence and extent of coronary atherosclerosis in patients 65years.MethodsWe evaluated 111 patients, aged 65 years, who underwent coronary angiography for presumedCAD. Transthorocic echocardiography (TTE) and multislice computed tomography (MSCT)were done. We identified the presence, absence, and amount of the valvular, aortic and coronarycalcifications. The severity of CAD was graded according to the number of plaques causing 50% diameter stenosis and the severe form was defined in our study model as more than 3obstructive lesions.ResultsPatients with obstructive CAD (OCAD) had higher proportion of AVS 57.8%. Those with severeform had higher proportion of both AVS (sensitivity 92%) and MAC (specificity 89%) by TTE.For detection of OCAD, Incremental value was gained over the CCS >0 when adding to it eitherthe presence of AVC or aortic wall calcification (AAC and/or DAC) increasing the sensitivityfrom 85.6% in CCS>0 alone to 90 % in presence of either of them and the accuracy from 80% to83 and 84% respectively. For detection of extensive form of CAD, incremental value was gainedover the CCS 100 when adding to it either the presence of AVC or MAC increasing thespecificity from 53% to 60 and 88% respectively and the PPV from 54% to 71.4 and 78.6%respectively.ConclusionThe presence of extracoronary calcification increases the diagnostic accuracy of CCS in detectionof CAD and its extent in patients 65 years.