Differences in the association of total versus local coronary artery calcium with acute coronary syndrome and culprit lesions in patients with acute chest pain: The coronary calcium paradox
Puchner SB, Mayrhofer T, Park J, Lu MT, Liu T, Maurovich-Horvat P, Ghemigian K, Bittner DO, Fleg JL, Udelson JE, Truong QA, Hoffmann U, Ferencik M (2018)
Publication Type: Journal article
Publication year: 2018
Journal
Book Volume: 274
Pages Range: 251-257
DOI: 10.1016/j.atherosclerosis.2018.04.017
Abstract
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.
Additional Organisation(s)
Involved external institutions
Massachusetts General Hospital
United States (USA) (US)
Cornell University
United States (USA) (US)
US National Institutes of Health (NIH)
United States (USA) (US)
Tufts University
United States (USA) (US)
Semmelweis University / Semmelweis Egyetem
Hungary (HU)
United States (USA) (US)
Cornell University
United States (USA) (US)
US National Institutes of Health (NIH)
United States (USA) (US)
Tufts University
United States (USA) (US)
Semmelweis University / Semmelweis Egyetem
Hungary (HU)
How to cite
APA:
Puchner, S.B., Mayrhofer, T., Park, J., Lu, M.T., Liu, T., Maurovich-Horvat, P.,... Ferencik, M. (2018). Differences in the association of total versus local coronary artery calcium with acute coronary syndrome and culprit lesions in patients with acute chest pain: The coronary calcium paradox. Atherosclerosis, 274, 251-257. https://doi.org/10.1016/j.atherosclerosis.2018.04.017
MLA:
Puchner, Stefan B., et al. "Differences in the association of total versus local coronary artery calcium with acute coronary syndrome and culprit lesions in patients with acute chest pain: The coronary calcium paradox." Atherosclerosis 274 (2018): 251-257.
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