Advertisement

Beware of calcium, but respect the narrowing

      Coronary artery calcifications have long been considered an indication for the presence of more advanced atherosclerosis because of the tendency of atherosclerotic plaques to incorporate calcium as they progress. New insights into the development of calcified plaques indicate that mineralization of the vascular wall is part of a chronic inflammatory process which involves the interaction of many cells and humoral factors, such as CD4+ T cells, CD40 ligand, macrophages, foam cells, osteoblasts, cytokines, selectins, myeloperoxidases, vascular adhesion molecules and smooth muscle cells. Some calcium deposits originate in the media and some occur in the intima [
      • Kalampogias A.
      • Siasos G.
      • Oikonomou E.
      • et al.
      Basic mechanisms in atherosclerosis: the role of calcium.
      ]. Thus, when identified by fluoroscopy in the angiography suite, it is frequently difficult to know whether these deposits are intra- or extra luminal and whether they participate in narrowing of the artery or not. When they do, the potential for complications of surgical or percutaneous revascularization – both intra-procedural and long-term, increases significantly.[
      • Madhavan M.V.
      • Tarigopula M.
      • Mintz G.S.
      • Maehara A.
      • Stone G.W.
      • Genereux P.
      Coronary artery calcification: pathogenesis and prognostic implications.
      ] For example, in a large series of patients (N = 6855) treated with percutaneous coronary intervention (PCI) for acute coronary syndromes with or without ST-segment elevation, the presence of moderate or severe calcifications (by fluoroscopy and adjudicated by an independent angiographic core laboratory) was associated with a significant increase in stent thrombosis and need for repeat revascularization (hazard ratio [HR]: 1.62; 95% confidence interval [CI]: 1.14 to 2.30; p = 0.007and HR: 1.44; 95% CI: 1.17 to 1.78; p = 0.0007, respectively) [
      • Genereux P.
      • Madhavan M.V.
      • Mintz G.S.
      • et al.
      Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes: pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trials.
      ].

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kalampogias A.
        • Siasos G.
        • Oikonomou E.
        • et al.
        Basic mechanisms in atherosclerosis: the role of calcium.
        Med. Chem. 2016; 12: 103-113
        • Madhavan M.V.
        • Tarigopula M.
        • Mintz G.S.
        • Maehara A.
        • Stone G.W.
        • Genereux P.
        Coronary artery calcification: pathogenesis and prognostic implications.
        J. Am. Coll. Cardiol. 2014; 63: 1703-1714
        • Genereux P.
        • Madhavan M.V.
        • Mintz G.S.
        • et al.
        Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes: pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trials.
        J. Am. Coll. Cardiol. 2014; 63: 1845-1854
        • Polonsky T.S.
        • McClelland R.L.
        • Jorgensen N.W.
        • et al.
        Coronary artery calcium score and risk classification for coronary heart disease prediction.
        JAMA. 2010; 303: 1610-1616
        • Kajander O.A.
        • Pinilla-Echeverri N.
        • Jolly S.S.
        • et al.
        Culprit plaque morphology in STEMI - an optical coherence tomography study: insights from the TOTAL-OCT substudy.
        EuroIntervention. 2016; 12: 716-723
        • Moe S.M.
        • Chen N.X.
        Mechanisms of vascular calcification in chronic kidney disease.
        J. Am. Soc. Nephrol. 2008; 19: 213-216
        • Glagov S.
        • Weisenberg E.
        • Zarins C.K.
        • Stankunavicius R.
        • Kolettis G.J.
        Compensatory enlargement of human atherosclerotic coronary arteries.
        N. Engl. J. Med. 1987; 316: 1371-1375
        • Go A.S.
        • Chertow G.M.
        • Fan D.
        • McCulloch C.E.
        • Hsu C.Y.
        Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.
        N. Engl. J. Med. 2004; 351: 1296-1305

      Linked Article

      • Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing
        AtherosclerosisVol. 262
        • Preview
          Coronary artery calcium (CAC) scoring is a predictor of future adverse clinical events, and a surrogate measure of overall coronary artery plaque burden. Coronary computed tomographic angiography (CCTA) is a contrast-enhanced method that allows for visualization of plaque as well as whether that plaque causes luminal narrowing. To date, the prognosis of individuals with CAC but without stenosis has not been reported. We explored the prevalence of CAC>0 and its prognostic utility for future mortality for patients without luminal narrowing by CCTA.
        • Full-Text
        • PDF
        Open Access