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.
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.
Atherosclerosis. 2018 Jul;274:251-257. doi: 10.1016/j.atherosclerosis.2018.04.017. Epub 2018 Apr 17.
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.
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.
Patients (n = 260) with vs. without ACS had higher total CAC score (median 229, 25-75 percentile 75-517 vs. 27, 25-75 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, 25-75 percentile 4-71 vs. 14, 25-75 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.
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.
总冠状动脉钙（CAC）负担与心血管风险增加相关，而局部 CAC 可能代表稳定斑块。我们确定了在疑似 ACS 患者中，总 CAC 与急性冠状动脉综合征（ACS）的关系以及局部 CAC 与罪犯病变的关系的差异。
我们对 37 例 ACS 患者和 223 例对照组进行了 CT 冠状动脉钙（CAC）和 CT 血管造影检查，以评估是否存在明显狭窄和高危斑块（正性重构、低 CT 衰减、餐巾环征、点状钙）。测量总和节段性 Agatston 评分。在 ACS 患者中评估罪犯病变。
与无 ACS 的患者相比，有 ACS 的患者（n=260）总 CAC 评分更高（中位数 229，25-75 百分位数 75-517 与 27，25-75 百分位数 0-99，p<0.001），明显狭窄的发生率更高（78%与 7%，p<0.001）和高危斑块（95%与 59%，p<0.001）。在 ACS 患者中，罪犯病变（n=41）与非罪犯病变（n=200）的节段性 CAC 评分相似（中位数 22，25-75 百分位数 4-71 与 14，25-75 百分位数 0-51；p=0.37），但明显狭窄的发生率更高（81%与 11%，p<0.001）和高危斑块（76%与 51%，p=0.005）。明显狭窄（优势比 40.2，95%CI 15.6-103.9，p<0.001）和高危斑块（优势比 3.4，95%CI 1.3-9.1，p=0.02），但不是节段性 CAC 评分（优势比 1.0，95%CI 1.0-1.0，p=0.47）与 ACS 的罪犯病变相关。
总 CAC 负担与 ACS 相关，但节段性 CAC 与罪犯病变不相关。我们的研究结果表明，总 CAC 而不是局部 CAC 是 ACS 风险的标志物，并支持广泛的局部 CAC 是斑块稳定性标志物的假说。
