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

    Research output: Contribution to journalArticle

    3 Citations (Scopus)

    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.

    Original languageEnglish (US)
    JournalAtherosclerosis
    DOIs
    StateAccepted/In press - Jan 1 2018

    Fingerprint

    Acute Pain
    Acute Coronary Syndrome
    Chest Pain
    Coronary Vessels
    Calcium
    Pathologic Constriction
    Odds Ratio
    Tomography

    Keywords

    • Acute coronary syndrome
    • Cardiac computed tomography
    • Coronary artery calcium
    • Coronary artery calcium density
    • Coronary artery calcium score
    • Culprit lesions
    • High-risk coronary plaque

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

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

    In: Atherosclerosis, 01.01.2018.

    Research output: Contribution to journalArticle

    Puchner, Stefan B. ; Mayrhofer, Thomas ; Park, Jakob ; Lu, Michael T. ; Liu, Ting ; Maurovich-Horvat, Pal ; Ghemigian, Khristine ; Bittner, Daniel O. ; Fleg, Jerome L. ; Udelson, James E. ; Truong, Quynh A. ; Hoffmann, Udo ; Ferencik, Maros. / 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. In: Atherosclerosis. 2018.
    @article{7bc202e5f82f423aa94f568ac9ff087c,
    title = "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",
    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.",
    keywords = "Acute coronary syndrome, Cardiac computed tomography, Coronary artery calcium, Coronary artery calcium density, Coronary artery calcium score, Culprit lesions, High-risk coronary plaque",
    author = "Puchner, {Stefan B.} and Thomas Mayrhofer and Jakob Park and Lu, {Michael T.} and Ting Liu and Pal Maurovich-Horvat and Khristine Ghemigian and Bittner, {Daniel O.} and Fleg, {Jerome L.} and Udelson, {James E.} and Truong, {Quynh A.} and Udo Hoffmann and Maros Ferencik",
    year = "2018",
    month = "1",
    day = "1",
    doi = "10.1016/j.atherosclerosis.2018.04.017",
    language = "English (US)",
    journal = "Atherosclerosis",
    issn = "0021-9150",
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    TY - JOUR

    T1 - Differences in the association of total versus local coronary artery calcium with acute coronary syndrome and culprit lesions in patients with acute chest pain

    T2 - The coronary calcium paradox

    AU - Puchner, Stefan B.

    AU - Mayrhofer, Thomas

    AU - Park, Jakob

    AU - Lu, Michael T.

    AU - Liu, Ting

    AU - Maurovich-Horvat, Pal

    AU - Ghemigian, Khristine

    AU - Bittner, Daniel O.

    AU - Fleg, Jerome L.

    AU - Udelson, James E.

    AU - Truong, Quynh A.

    AU - Hoffmann, Udo

    AU - Ferencik, Maros

    PY - 2018/1/1

    Y1 - 2018/1/1

    N2 - 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.

    AB - 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.

    KW - Acute coronary syndrome

    KW - Cardiac computed tomography

    KW - Coronary artery calcium

    KW - Coronary artery calcium density

    KW - Coronary artery calcium score

    KW - Culprit lesions

    KW - High-risk coronary plaque

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    U2 - 10.1016/j.atherosclerosis.2018.04.017

    DO - 10.1016/j.atherosclerosis.2018.04.017

    M3 - Article

    AN - SCOPUS:85046147205

    JO - Atherosclerosis

    JF - Atherosclerosis

    SN - 0021-9150

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