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Comparison of coronary calcium in stable angina pectoris and in first acute myocardial infarction utilizing double
J Shemesh1, C I Stroh, A Tenenbaum
1Cardiac Rehabilitation Institute, the Chaim Sheba Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
Insights
Extensive coronary calcium is common in chronic stable angina patients. However, a first acute myocardial infarction (AMI) often involves arteries with mild or no calcification, challenging previous assumptions about atherosclerosis progression.
Area of Science:
- Cardiology
- Radiology
- Atherosclerosis Research
Background:
- Coronary calcium is linked to atherosclerosis, but its precise role in acute and chronic coronary syndromes is not fully understood.
- Understanding coronary calcium patterns may offer insights into the differing pathologies of acute myocardial infarction and stable angina.
Purpose of the Study:
- To investigate and compare coronary calcium patterns in patients with chronic stable angina versus those who have survived a first acute myocardial infarction.
- To determine if the extent of coronary calcification differs between these two patient groups.
Main Methods:
- Utilized double helical computerized tomography to evaluate coronary calcium patterns.
- Analyzed 149 patients: 47 with chronic stable angina (SAP) and 102 survivors of a first acute myocardial infarction (AMI).
- Categorized calcific lesions into mild, intermediate, and extensive based on extent.
Main Results:
- 100% of stable angina patients and 81% of AMI patients showed coronary calcium.
- Stable angina patients predominantly had extensive calcification (79%), while AMI patients showed more mild (18%) and intermediate (49%) calcification.
- Culprit arteries in AMI patients were often mildly calcified (41%) or noncalcified (22%), with only 10% showing extensive calcification.
- Mean calcium scores were significantly lower in AMI patients compared to SAP patients.
Conclusions:
- Extensive coronary calcification is characteristic of chronic stable angina.
- A first acute myocardial infarction is more frequently associated with mildly calcified or noncalcified culprit arteries.
- These findings suggest distinct pathophysiological pathways for stable angina and acute myocardial infarction, despite the presence of atherosclerosis.
Abstract:
Although coronary calcium is invariably associated with atherosclerosis, its role in the pathogenesis of acute and chronic coronary syndromes remains unclear. Utilizing double helical computerized tomography we evaluated the coronary calcium patterns in 149 patients: 47 with chronic stable angina (SAP) compared with 102 patients surviving a first acute myocardial infarction (AMI). Prevalence of coronary calcium was 81% among the AMI patients and 100% in the stable angina patients. The 547 calcific lesions identified in the AMI patients and the 1,242 lesions in the stable angina patients were categorized into 3 groups according to their extent: mild, intermediate, and extensive. The age-adjusted percentages of the highest level of calcification among AMI versus stable angina patients were: mild 18% vs 3%, intermediate 49% vs 18%, and extensive lesions 33% vs 79%, respectively (p < 0.01). In the AMI group, 73 culprit arteries were identified: 16 (22%) had no calcium detected, whereas 30 (41%) had mild lesions, 20 (27%) had intermediate forms, and only 7 (10%) had extensive lesions. The age-adjusted mean of the natural logarithm transformation of total calcium scores +1 was significantly lower in patients with AMI than in those with SAP (4.1 [95% confidence interval 3.7 to 4.4) vs 5.3 [95% confidence interval 4.8 to 5.8]). Thus, double helical computerized tomography demonstrates that extensive calcium characterizes the coronary arteries of patients with chronic stable angina, whereas a first AMI most often occurs in mildly calcified or noncalcified culprit arteries.