Introduction: The association between a high calcium score at the level of the unstable coronary lesions and the different characteristic of culprit lesions which result in an acute coronary syndrome (ACS) has not been described yet. We aimed to study the correlation between the accumulation of calcium within the vessel wall of a coronary artery and the plaque burden of culprit lesions that develop an acute coronary event. Material and methods: A total of 45 patients with ACS (22 unstable angina, 23 nonST elevation myocardial infarction) underwent 64-slice CCTA. In all patients a complex CT analysis of the culprit plaques was performed and the calcium score for each coronary artery was computed. Results: We found a significant correlation between a calcium score higher than 100 and the plaque volume (r = 0.85. p = 0.01). Selecting a cut-off value of 100 HU for regional calcium score at the level of the coronary artery, we found that those arteries with Ca score higher than 100 presented significantly larger plaque volumes than the ones with calcium score below 100 (110.8 ml vs 82.4 ml, p <0.0001 for left anterior descending artery, 111.09 ml vs 82.5 ml, p = 0.0005 for circumflex artery, and 132.78 ml vs 76.23 ml for right coronary artery). Conclusion: Our data shows that in ACS, the severity of the culprit lesions correlates with regional accumulation of calcium within the vessel wall.
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1. Pavan KCh Aloke VF Gardner C et al. Relationship between Coronary Artery Calcium Score by Multidetector Computed Tomography and Plaque Components by Virtual Histology Intravascular Ultrasound. J Am Coll Cardiol. 2007;50:940-9.
2. Rubinshtein R Gaspar T Halon DA et al. Prevalence and extent of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrome. Am J Cardio. 2007;99:472-475.
3. Choi YH Hong JY Myung H et al. Relationship between Coronary Artery Calcium Score by Multidetector Computed Tomography and Plaque Components by Virtual Histology Intravascular Ultrasound. J Korean Med Sci. 2011;26(8):1052-1060.
4. Yang X Gai LY Li P et al. Diagnostic accuracy of dual-source CT angiography and coronary risk stratifi cation. Vasc Health Risk Manag. 2010;6:935-41.
5. Benedek Th Bucur O Pascanu I Benedek I. Analysis of coronary plaque morphology by 64-multislice computed tomography coronary angiography and calcium scoring in patients with type 2 diabetes mellitus. Acta endocrinologica. 2011;71:59-68.
6. Liu YC Sun Z Tsay PK et al. Signifi cance of Coronary Calcifi cation for prediction of coronary artery disease and cardiac events based on 64-slice coronary computed tomography angiography. BioMed Research International 2013 9.
7. van Werkhoven JM Schuijf JD Gaemperli O et al. Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease. Eur Heart J. 2009;30(21):2622-9.
8. Benedek Th Gyöngyösi M Benedek I. Multislice Computed Tomographic Coronary Angiography for Quantitative Assessment of Culprit Lesions in Acute Coronary Syndromes. Canadian Journal of Cardiology. 2013;29(3): 364-371.
9. Shapiro E Bush ED. Visualizing Vulnerability Toward a new cardiac score. J Am Coll Cardiol. 2013;61(22):2306-2308.
10. Takashi K Maehara A Mintz SB et al. The Dynamic Nature of Coronary Artery Lesion Morphology Assessed by Serial Virtual Histology Intravascular Ultrasound Tissue Characterization. J Am Coll Cardiol. 2010;55(15):1590-1597.
11. Ho JS Fitzgerald SJ Stolfus LL et al. Relation of a coronary artery calcium score higher than 400 to coronary stenoses detected using multidetector computed tomography and to traditional cardiovascular risk factors. Am J Cardiol. 2008;101(10):1444-7.