TY - JOUR
T1 - Differences in the association of total versus local coronary artery calcium with acute coronary syndrome and culprit lesions in patients with acute chest pain
T2 - The coronary calcium paradox
AU - Puchner, Stefan B.
AU - Mayrhofer, Thomas
AU - Park, Jakob
AU - Lu, Michael T.
AU - Liu, Ting
AU - Maurovich-Horvat, Pal
AU - Ghemigian, Khristine
AU - Bittner, Daniel O.
AU - Fleg, Jerome L.
AU - Udelson, James E.
AU - Truong, Quynh A.
AU - Hoffmann, Udo
AU - Ferencik, Maros
N1 - Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2018/7
Y1 - 2018/7
N2 - Background and aims: Total coronary artery calcium (CAC) burden is associated with an increased cardiovascular risk, while local CAC may represent stable plaques. We determined differences in relationship of total CAC with acute coronary syndrome (ACS) and local CAC with culprit lesions in patients with suspected ACS. Methods: We performed computed tomography (CT) for CAC and CT angiography to assess the presence of significant stenosis and high-risk plaque (positive remodeling, low CT attenuation, napkin-ring sign, spotty calcium) in 37 patients with ACS and 223 controls. Total and segmental Agatston scores were measured. Culprit lesions were assessed in subjects with ACS. Results: Patients (n = 260) with vs. without ACS had higher total CAC score (median 229, 25th-75th percentile 75–517 vs. 27, 25th-75th percentile 0–99, p<0.001), higher prevalence of significant stenosis (78% vs. 7%, p<0.001) and high-risk plaque (95% vs. 59%, p<0.001). In those with ACS, culprit (n = 41) vs. non-culprit (n = 200) lesions, had similar segmental CAC score (median 22, 25th-75th percentile 4–71 vs. 14, 25th-75th percentile 0–51; p=0.37), but higher prevalence of significant stenosis (81% vs. 11%, p<0.001) and high-risk plaque (76% vs. 51%, p=0.005). Significant stenosis (odds ratio 40.2, 95%CI 15.6–103.9, p<0.001) and high-risk plaque (odds ratio 3.4, 95%CI 1.3–9.1, p=0.02), but not segmental CAC score (odds ratio 1.0, 95%CI 1.0–1.0, p=0.47), were associated with culprit lesions of ACS. Conclusions: Total CAC burden was associated with ACS but segmental CAC was not associated with culprit lesions. Our findings suggest that total but not local CAC is a marker of ACS risk and support the hypothesis that extensive local CAC is a marker of plaque stability.
AB - Background and aims: Total coronary artery calcium (CAC) burden is associated with an increased cardiovascular risk, while local CAC may represent stable plaques. We determined differences in relationship of total CAC with acute coronary syndrome (ACS) and local CAC with culprit lesions in patients with suspected ACS. Methods: We performed computed tomography (CT) for CAC and CT angiography to assess the presence of significant stenosis and high-risk plaque (positive remodeling, low CT attenuation, napkin-ring sign, spotty calcium) in 37 patients with ACS and 223 controls. Total and segmental Agatston scores were measured. Culprit lesions were assessed in subjects with ACS. Results: Patients (n = 260) with vs. without ACS had higher total CAC score (median 229, 25th-75th percentile 75–517 vs. 27, 25th-75th percentile 0–99, p<0.001), higher prevalence of significant stenosis (78% vs. 7%, p<0.001) and high-risk plaque (95% vs. 59%, p<0.001). In those with ACS, culprit (n = 41) vs. non-culprit (n = 200) lesions, had similar segmental CAC score (median 22, 25th-75th percentile 4–71 vs. 14, 25th-75th percentile 0–51; p=0.37), but higher prevalence of significant stenosis (81% vs. 11%, p<0.001) and high-risk plaque (76% vs. 51%, p=0.005). Significant stenosis (odds ratio 40.2, 95%CI 15.6–103.9, p<0.001) and high-risk plaque (odds ratio 3.4, 95%CI 1.3–9.1, p=0.02), but not segmental CAC score (odds ratio 1.0, 95%CI 1.0–1.0, p=0.47), were associated with culprit lesions of ACS. Conclusions: Total CAC burden was associated with ACS but segmental CAC was not associated with culprit lesions. Our findings suggest that total but not local CAC is a marker of ACS risk and support the hypothesis that extensive local CAC is a marker of plaque stability.
KW - Acute coronary syndrome
KW - Cardiac computed tomography
KW - Coronary artery calcium
KW - Coronary artery calcium density
KW - Coronary artery calcium score
KW - Culprit lesions
KW - High-risk coronary plaque
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U2 - 10.1016/j.atherosclerosis.2018.04.017
DO - 10.1016/j.atherosclerosis.2018.04.017
M3 - Article
C2 - 29703635
AN - SCOPUS:85046147205
SN - 0021-9150
VL - 274
SP - 251
EP - 257
JO - Atherosclerosis
JF - Atherosclerosis
ER -