Coronary calcification identifies the vulnerable patient rather than the vulnerable Plaque

Atherosclerosis. 2013 Jul;229(1):124-9. doi: 10.1016/j.atherosclerosis.2013.03.010. Epub 2013 Mar 21.


Objective: Presence of coronary artery calcium (CAC) is associated with a high risk of adverse cardiovascular outcomes. Nevertheless, although CAC is a marker of atherosclerosis it is still uncertain whether CAC is a marker of plaque vulnerability. Therefore, the aim of this study was to verify if calcification identifies a vulnerable patient rather than the vulnerable plaque.

Methods: A morphologic and morphometric study on 960 coronary segments (CS) of 2 groups of patients was performed: (i) 17 patients who died from AMI (510 CS); (ii) 15 age-matched control patients without cardiac history (CTRL, 450 CS).

Results: Calcification was found in 47% CS of AMI and in 24.5% CS of CTRL. The area of calcification was significantly higher in AMI compared to CTRL (p = 0.001). An inverse correlation was found between the extension of calcification and cap inflammation (r(2) = 0.017; p = 0.003). Multivariate regression analysis demonstrated that the calcification was not correlated with the presence of unstable plaques (p = 0.65). Similarly, the distance of calcification from the lumen did not represent an instability factor (p = 0.68).

Conclusion: The present study suggests that CAC score evaluation represents a valid method to define the generic risk of acute coronary events in a population, but it is not useful to identify the vulnerable plaque that need to be treated in order to prevent an acute event.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Coronary Artery Disease / mortality*
  • Coronary Artery Disease / pathology*
  • Coronary Thrombosis / mortality
  • Coronary Thrombosis / pathology
  • Coronary Vessels / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / mortality
  • Myocardial Infarction / pathology
  • Plaque, Atherosclerotic / mortality*
  • Plaque, Atherosclerotic / pathology*
  • Risk Assessment / methods
  • Risk Factors
  • Vascular Calcification / mortality*
  • Vascular Calcification / pathology*
  • Vasculitis / mortality
  • Vasculitis / pathology