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

Stefan B Puchner; Thomas Mayrhofer; Jakob Park; Michael T Lu; Ting Liu; Pal Maurovich-Horvat; Khristine Ghemigian; Daniel O Bittner; Jerome L Fleg; James E Udelson; Quynh A Truong; Udo Hoffmann; Maros Ferencik

doi:10.1016/j.atherosclerosis.2018.04.017

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. 2018 Jul:274:251-257. doi: 10.1016/j.atherosclerosis.2018.04.017. Epub 2018 Apr 17.

Authors

Affiliations

¹ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
² Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
³ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁴ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China.
⁵ MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.
⁶ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, University Hospital Erlangen, Germany.
⁷ Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
⁸ Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA.
⁹ Department of Radiology and Division of Cardiology, Weill Cornell Medical College, New York, NY, USA.
¹⁰ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA. Electronic address: ferencik@ohsu.edu.

PMID: 29703635
PMCID: PMC5999579
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, 25^th-75^th percentile 75-517 vs. 27, 25^th-75^th 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, 25^th-75^th percentile 4-71 vs. 14, 25^th-75^th 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.

Keywords: Acute coronary syndrome; Cardiac computed tomography; Coronary artery calcium; Coronary artery calcium density; Coronary artery calcium score; Culprit lesions; High-risk coronary plaque.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome / diagnostic imaging*
Acute Coronary Syndrome / epidemiology
Aged
Angina Pectoris / diagnostic imaging*
Angina Pectoris / epidemiology
Computed Tomography Angiography*
Coronary Angiography / methods*
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / epidemiology
Coronary Stenosis / diagnostic imaging*
Coronary Stenosis / epidemiology
Coronary Vessels / diagnostic imaging*
Female
Humans
Male
Middle Aged
Multidetector Computed Tomography*
Plaque, Atherosclerotic
Predictive Value of Tests
Prevalence
Prognosis
Randomized Controlled Trials as Topic
Retrospective Studies
Risk Assessment
Risk Factors
Rupture, Spontaneous
Severity of Illness Index
United States / epidemiology
Vascular Calcification / diagnostic imaging*
Vascular Calcification / epidemiology

Abstract

Publication types

MeSH terms

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