Coronary Artery Calcification: From Molecular Mechanisms to Interventional Strategies

Area of Science:

• Cardiovascular Medicine
• Vascular Biology
• Medical Imaging

Background:

• Coronary artery calcification (CAC) signifies advanced atherosclerosis, impacting cardiovascular risk, plaque biology, and percutaneous coronary intervention (PCI) complexity.
• Vascular calcification is an active process involving cellular changes, inflammation, and mineral metabolism, with distinct phenotypes affecting plaque stability.
• CAC prevalence rises with age and varies by sex, influenced by cardiometabolic factors, chronic kidney disease, inflammation, and genetics.

Purpose of the Study:

• To review current knowledge on vascular calcification mechanisms, clinical determinants, diagnostic methods, and therapeutic implications.
• To explore the relationship between different CAC phenotypes and plaque stability.
• To highlight the role of imaging in assessing calcified lesions and optimizing PCI.

Main Methods:

• Literature review summarizing research on vascular calcification mechanisms and clinical significance.
• Analysis of distinct calcification phenotypes (micro-calcifications, dense calcifications) and their association with plaque stability.
• Evaluation of diagnostic tools like computed tomography (CT) for CAC quantification and intravascular imaging (IVUS, OCT) for detailed lesion characterization.

Main Results:

• Vascular calcification is an active, regulated process involving vascular smooth muscle cell transdifferentiation and inflammatory pathways.
• Micro- and spotty calcifications are linked to plaque vulnerability, while dense calcifications characterize stable lesions.
• Noninvasive CT is key for risk stratification, while intravascular imaging guides complex PCI in heavily calcified lesions.

Conclusions:

• CAC is a critical marker of atherosclerosis and cardiovascular risk, with diverse phenotypes influencing plaque stability.
• Understanding the mechanisms and imaging characteristics of CAC is vital for effective cardiovascular risk assessment and management.
• Intravascular imaging-guided strategies are essential for optimizing PCI outcomes in patients with severe coronary calcification.