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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary calcification compared in patients with acute versus in those with chronic coronary events by using
Joseph Shemesh1, Sara Apter, Yacov Itzchak
1Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Hashomer, 52621, Israel. dshemesh@netvision.net.il
Insights
Patients with acute coronary events show mild calcific atherosclerotic lesions, whereas chronic coronary events are linked to diffuse, high-attenuation calcified plaques. This study used dual-sector spiral computed tomography (CT) to analyze coronary calcium in hypertensive patients.
Area of Science:
- Cardiovascular Imaging
- Atherosclerosis Research
- Hypertension Studies
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Hypertension is a major risk factor for CAD and atherosclerotic plaque development.
- Understanding the characteristics of calcific lesions in acute versus chronic coronary events is crucial for risk stratification and management.
Purpose of the Study:
- To compare the characteristics of underlying calcific atherosclerotic lesions in patients experiencing acute versus chronic coronary events.
- To investigate the role of dual-sector spiral computed tomography (CT) in differentiating lesion types.
- To analyze coronary calcium burden in hypertensive individuals with different coronary event presentations.
Main Methods:
- Analysis of 884 calcific lesions in 50 hypertensive patients with coronary events over a 3-year follow-up.
- Dual-sector spiral CT imaging performed within 12 months prior to the event.
- Categorization of patients into acute (n=29) and chronic (n=21) coronary event groups.
- Statistical comparison using chi-squared, Fisher exact, two-sample t-tests, and Wilcoxon rank sum tests.
Main Results:
- High prevalence of coronary calcium (>0) observed in both groups (93% acute, 95% chronic).
- Significantly higher median number of lesions per patient in the chronic group (35) compared to the acute group (9) (P <.001).
- Median total coronary calcium score (TCS) was substantially higher in the chronic group (906) versus the acute group (63) (P <.01).
Conclusions:
- Acute coronary events are associated with a mild degree of coronary calcification.
- Chronic coronary events are characterized by diffuse, high-attenuation calcific plaques.
- Dual-sector spiral CT effectively differentiates coronary calcification patterns related to acute versus chronic coronary syndromes in hypertensive patients.
Purpose:
To compare underlying calcific atherosclerotic lesions in acute versus chronic coronary events in patients with hypertension by using dual-sector spiral computed tomography (CT).
Materials And Methods:
Eight hundred eighty-four calcific lesions were analyzed in a cohort of 50 patients (39 men, 11 women; age range, 55-79 years; mean age, 66 years +/- 6 [SD]) with hypertension who sustained a coronary event during 3-year follow-up. All underwent dual-sector spiral CT within 12 months before the event. Twenty-nine patients had an acute event (acute group): acute myocardial infarction, 20; unstable angina pectoris, six; acute ischemia, two; sudden death, one. Twenty-one patients had chronic manifestations of obstructive coronary disease (chronic group): severe stable angina, five; angiographically identified disease, 12; disease requiring angioplasty, two; and disease requiring bypass surgery, two. To examine differences between the two study groups, the chi(2) or Fisher exact test was applied to categorical parameters and the two-sample t test or Wilcoxon rank sum test to quantitative parameters.
Results:
High prevalence of coronary calcium (total coronary calcium score [TCS] >0) was observed in both groups: 93% (27 of 29) in the acute and 95% (20 of 21) in the chronic group. There were 518 lesions in the chronic and 366 in the acute group, with a median number of 35 and nine lesions per patient, respectively (P <.001). The median TCS was 906 for the chronic and 63 for the acute group (P <.01).
Conclusion:
A mild degree of calcification characterizes patients with acute coronary events, while diffuse high-attenuation calcific plaques are associated with chronic coronary events.
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