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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
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Coronary calcification in patients presenting with acute coronary syndromes: insights from the MATRIX trial

Jorge Sanz-Sanchez1,2, Hector M Garcia-Garcia3, Mattia Branca4

  • 1Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain.

European Heart Journal. Acute Cardiovascular Care
|October 9, 2023
PubMed

Insights

Severe coronary calcification in acute coronary syndromes (ACS) patients is linked to worse outcomes, including higher rates of major adverse cardiovascular events (MACE) and mortality, regardless of treatment strategy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Coronary calcification assessment is crucial in acute coronary syndromes (ACS).
  • The impact of severe coronary calcification on clinical outcomes across revascularization strategies in ACS patients is understudied.
  • Coronary angiography is a key diagnostic tool for evaluating coronary calcification.

Purpose of the Study:

  • To investigate the role of coronary calcification, detected via coronary angiography, in patients presenting with acute coronary syndromes (ACS).
  • To evaluate the association between severe coronary calcification and clinical outcomes in the entire spectrum of ACS patients.
  • To determine if coronary calcification influences outcomes independently of revascularization strategy.

Main Methods:

  • Post hoc analysis of the MATRIX programme, including 7446 patients with available coronary calcification data.
  • Coronary calcification severity was assessed by coronary angiography.
  • Primary endpoint: major adverse cardiovascular events (MACE) – all-cause mortality, myocardial infarction (MI), or stroke at 365 days.

Main Results:

  • 11.7% of patients had severe coronary calcification.
  • Severe calcification was associated with fewer percutaneous coronary interventions and more coronary artery bypass grafting or medical therapy-only.
  • Patients with severe calcification had significantly higher 1-year MACE (27.1% vs. 15%), mortality (8.6% vs. 3.7%), and MI (20.1% vs. 11.5%) rates compared to those without severe calcification.

Conclusions:

  • Severe coronary calcification in ACS patients is independently associated with significantly worse clinical outcomes.
  • This association persists irrespective of the chosen management or revascularization strategy.
  • Findings highlight the prognostic significance of coronary calcification in ACS management.
Abstract

Keywords:
Acute coronary syndromesCoronary artery bypass graftingCoronary calcificationMedical therapyPercutaneous coronary intervention

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