Highlights
- •Total coronary artery calcium burden was a good predictor of acute coronary syndrome (ACS) in acute chest pain patients.
- •Culprit lesions of ACS were characterized by significant stenosis and high-risk plaque.
- •Culprit lesions of ACS had smaller amounts of coronary calcium.
- •The prevalence of high-risk plaque was inversely related to segmental coronary calcium score.
- •Local extensive coronary calcium may represent more stable stage of atherosclerosis.
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.
Graphical abstract
Graphical Abstract
Keywords
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Article Info
Publication History
Published online: April 16, 2018
Accepted:
April 12,
2018
Received in revised form:
April 5,
2018
Received:
October 1,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
