(Circulation. 1997;96:1461-1469.)
© 1997 American Heart Association, Inc.
Articles |
Coronary Artery Calcium in Acute Coronary Syndromes
A Comparative Study of Electron-Beam Computed Tomography, Coronary Angiography, and Intracoronary Ultrasound in Survivors of Acute Myocardial Infarction and Unstable Angina
From the Department of Cardiology, University Clinic Essen (Germany) (A.S., D.B., G.G., J.G., M.H., R.E.); the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn (A.S., J.R.); the Institute for Diagnostic and Interventional Radiology, University Witten/Herdecke, Mülheim an der Ruhr, Germany (R.S.); and the Institute for Development and Research of Microtechnology, University of Bochum (Germany) (D.G.).
Correspondence to Axel Schmermund, MD, Mayo Clinic and Foundation, Cardiovascular Diseases, E 16-B Mayo, 200 First St SW, Rochester, MN 55905. E-mail schmermund.axel{at}mayo.edu
Background Quantification of coronary artery calcified plaques by electron-beam CT (EBCT) may predict cardiovascular events. However, whereas advanced coronary atherosclerotic plaques can be identified, mildly stenotic lipid-rich (soft) plaques may be difficult to detect. The value of EBCT in a subgroup of patients has therefore been questioned. To investigate this, we evaluated patients with acute coronary syndromes by EBCT and compared the results with coronary angiography and, in patients with an indeterminate angiogram, intracoronary ultrasound (ICUS).
Methods and Results EBCT was performed in 118 consecutive
patients (57±11 years of age) with previous myocardial infarction
(n=101) or unstable angina (n=17). A standard protocol requiring a CT
density >130 Hounsfield units in an area 
1.03 mm2
was used for the definition of coronary artery calcium. We
found that 110 patients had moderate to severe coronary artery
disease by coronary angiography, and 8 had either mildly
stenotic plaques at a single site (4 patients, confirmed by
ICUS) or nonatherosclerotic causes of the unstable coronary
syndrome (4 patients). One hundred and five of the 110 patients (96%)
with moderate to severe angiographic disease but only 1 of the 8 other
patients (13%) had a positive EBCT. Patients with acute
coronary syndromes and negative EBCTs were significantly
younger than patients with positive EBCTs (46±12 versus 58±10 years,
P<.001), and a higher percentage was actively smoking
(100% of the smokers versus 46%, P<.05).
Conclusions The vast majority of patients with acute coronary syndromes and at least moderate angiographic disease have identifiable coronary calcium by EBCT. Those patients with negative EBCTs have minimal or no atherosclerotic plaque formation. They are younger and tend to be active cigarette smokers.
Key Words: angina • calcium • coronary disease • imaging • myocardial infarction
This article has been cited by other articles:
 |
|
 |
|
  C. S. White and D. Kuo Chest Pain in the Emergency Department: Role of Multidetector CT Radiology, December 1, 2007; 245(3): 672 - 681. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Budoff, S. Achenbach, R. S. Blumenthal, J. J. Carr, J. G. Goldin, P. Greenland, A. D. Guerci, J. A.C. Lima, D. J. Rader, G. D. Rubin, et al. Assessment of Coronary Artery Disease by Cardiac Computed Tomography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology Circulation, October 17, 2006; 114(16): 1761 - 1791. [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. Berman, R. Hachamovitch, L. J. Shaw, J. D. Friedman, S. W. Hayes, L. E.J. Thomson, D. S. Fieno, G. Germano, N. D. Wong, X. Kang, et al. Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Noninvasive Risk Stratification and a Conceptual Framework for the Selection of Noninvasive Imaging Tests in Patients with Known or Suspected Coronary Artery Disease J. Nucl. Med., July 1, 2006; 47(7): 1107 - 1118. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.-H. Huang, L.-C. Chen, H.-B. Leu, P. Y.-A. Ding, J.-W. Chen, T.-C. Wu, and S.-J. Lin Enhanced Coronary Calcification Determined by Electron Beam CT Is Strongly Related to Endothelial Dysfunction in Patients With Suspected Coronary Artery Disease Chest, August 1, 2005; 128(2): 810 - 815. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.E. Nissen Identifying patients at risk: novel diagnostic techniques Eur. Heart J. Suppl., July 1, 2004; 6(suppl_C): C15 - C20. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Hokanson, T. MacKenzie, G. Kinney, J. K. Snell-Bergeon, D. Dabelea, J. Ehrlich, R. H. Eckel, and M. Rewers Evaluating Changes in Coronary Artery Calcium: An Analytic Method That Accounts for Interscan Variability Am. J. Roentgenol., May 1, 2004; 182(5): 1327 - 1332. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Herzog, S. Dogan, T. Diebold, M. F. Khan, H. Ackermann, S. Schaller, T. G. Flohr, G. Wimmer-Greinecker, A. Moritz, and T. J. Vogl Multi-Detector Row CT versus Coronary Angiography: Preoperative Evaluation before Totally Endoscopic Coronary Artery Bypass Grafting Radiology, October 1, 2003; 229(1): 200 - 208. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Pohle, D Ropers, R Maffert, P Geitner, W Moshage, M Regenfus, M Kusus, W G Daniel, and S Achenbach Coronary calcifications in young patients with first, unheralded myocardial infarction: a risk factor matched analysis by electron beam tomography Heart, June 1, 2003; 89(6): 625 - 628. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G. O'Malley, I. M. Feuerstein, and A. J. Taylor Impact of Electron Beam Tomography, With or Without Case Management, on Motivation, Behavioral Change, and Cardiovascular Risk Profile: A Randomized Controlled Trial JAMA, May 7, 2003; 289(17): 2215 - 2223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Shemesh, S. Apter, Y. Itzchak, and M. Motro Coronary Calcification Compared in Patients with Acute versus in Those with Chronic Coronary Events by Using Dual-Sector Spiral CT Radiology, February 1, 2003; 226(2): 483 - 488. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Erbell, T. Budde, G. Kerkhoff, S. Mohlenkamp, and A. Schmermund Understanding the pathophysiology of the arterial wall: which method should we choose? Electron beam computed tomography Eur. Heart J. Suppl., September 1, 2002; 4(suppl_F): F47 - F53. [Abstract] [PDF]
|
|
|
|
 |
|
 J. E. Hokanson, S. Cheng, J. K. Snell-Bergeon, B. A. Fijal, M. A. Grow, C. Hung, H. A. Erlich, J. Ehrlich, R. H. Eckel, and M. Rewers A Common Promoter Polymorphism in the Hepatic Lipase Gene (LIPC-480C>T) Is Associated With an Increase in Coronary Calcification in Type 1 Diabetes Diabetes, April 1, 2002; 51(4): 1208 - 1213. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Wayhs, A. Zelinger, and P. Raggi High coronary artery calcium scores pose an extremely elevated risk for hard events J. Am. Coll. Cardiol., January 16, 2002; 39(2): 225 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund and R. Erbel Unstable Coronary Plaque and Its Relation to Coronary Calcium Circulation, October 2, 2001; 104(14): 1682 - 1687. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Weiss Another Calcium Paradox? Arterioscler. Thromb. Vasc. Biol., October 1, 2001; 21(10): 1561 - 1562. [Full Text] [PDF]
|
|
|
|
|
|
P. C. Keelan, L. F. Bielak, K. Ashai, L. S. Jamjoum, A. E. Denktas, J. A. Rumberger, P. F. Sheedy, II, P. A. Peyser, and R. S. Schwartz Long-Term Prognostic Value of Coronary Calcification Detected by Electron-Beam Computed Tomography in Patients Undergoing Coronary Angiography Circulation, July 24, 2001; 104(4): 412 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund, D. Baumgart, S. Mohlenkamp, P. Kriener, H. Pump, D. Gronemeyer, R. Seibel, and R. Erbel Natural History and Topographic Pattern of Progression of Coronary Calcification in Symptomatic Patients : An Electron-Beam CT Study Arterioscler. Thromb. Vasc. Biol., March 1, 2001; 21(3): 421 - 426. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Eifinger, F. Wahn, U. Querfeld, M. Pollok, A. Gevargez, P. Kriener, and D. Gronemeyer Coronary artery calcifications in children and young adults treated with renal replacement therapy Nephrol. Dial. Transplant., November 1, 2000; 15(11): 1892 - 1894. [Full Text] [PDF]
|
|
|
|
 |
|
 A Schmermund, D Baumgart, S Sack, S Mohlenkamp, D Gronemeyer, R Seibel, and R Erbel Assessment of coronary calcification by electron-beam computed tomography in symptomatic patients with normal, abnormal or equivocal exercise stress test Eur. Heart J., October 2, 2000; 21(20): 1674 - 1682. [Abstract] [PDF]
|
|
|
|
|
|
L. F. Bielak, J. A. Rumberger, P. F. Sheedy II, R. S. Schwartz, and P. A. Peyser Probabilistic Model for Prediction of Angiographically Defined Obstructive Coronary Artery Disease Using Electron Beam Computed Tomography Calcium Score Strata Circulation, July 25, 2000; 102(4): 380 - 385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. O'Rourke, B. H. Brundage, V. F. Froelicher, P. Greenland, S. M. Grundy, R. Hachamovitch, G. M. Pohost, L. J. Shaw, W. S. Weintraub, W. L. Winters Jr, et al. American College of Cardiology/American Heart Association Expert Consensus Document on Electron-Beam Computed Tomography for the Diagnosis and Prognosis of Coronary Artery Disease : Committee Members Circulation, July 4, 2000; 102(1): 126 - 140. [Full Text] [PDF]
|
|
|
|
|
|
R. A. O'Rourke, B. H. Brundage, V. F. Froelicher, P. Greenland, S. M. Grundy, R. Hachamovitch, G. M. Pohost, L. J. Shaw, W. S. Weintraub, W. L. Winters Jr, et al. American College of Cardiology/American Heart Association expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease J. Am. Coll. Cardiol., July 1, 2000; 36(1): 326 - 340. [Full Text] [PDF]
|
|
|
|
|
|
R Erbel, A Schmermund, S Mohlenkamp, S Sack, and D Baumgart Electron-beam computed tomography for detection of early signs of coronary arteriosclerosis Eur. Heart J., May 1, 2000; 21(9): 720 - 732. [PDF]
|
|
|
|
|
|
A. J. Taylor, A. P. Burke, P. G. O’Malley, A. Farb, G. T. Malcom, J. Smialek, and R. Virmani A Comparison of the Framingham Risk Index, Coronary Artery Calcification, and Culprit Plaque Morphology in Sudden Cardiac Death Circulation, March 21, 2000; 101(11): 1243 - 1248. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Raggi, T. Q. Callister, B. Cooil, Z.-X. He, N. J. Lippolis, D. J. Russo, A. Zelinger, and J. J. Mahmarian Identification of Patients at Increased Risk of First Unheralded Acute Myocardial Infarction by Electron-Beam Computed Tomography Circulation, February 29, 2000; 101(8): 850 - 855. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nishino, M. J. Malloy, J. Naya-Vigne, J. Russell, J. P. Kane, and R. F. Redberg Lack of association of lipoprotein(a) levels with coronary calcium deposits in asymptomatic postmenopausal women J. Am. Coll. Cardiol., February 1, 2000; 35(2): 314 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund, K. R. Bailey, J. A. Rumberger, J. E. Reed, P. F. Sheedy II, and R. S. Schwartz An algorithm for noninvasive identification of angiographic three-vessel and/or left main coronary artery disease in symptomatic patients on the basis of cardiac risk and electron-beam computed tomographic calcium scores J. Am. Coll. Cardiol., February 1, 1999; 33(2): 444 - 452. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Doherty, R. C. Detrano, A. Schmermund, D. Baumgart, R. Erbel, and J. A. Rumberger Coronary Calcium, Subsequent Events, and Selection Bias • Response Circulation, June 30, 1998; 97(25): 2586 - 2588. [Full Text]
|
|
|
|
|
|
T. J. Vogl, N. D. Abolmaali, T. Diebold, K. Engelmann, M. Ay, S. Dogan, G. Wimmer-Greinecker, A. Moritz, and C. Herzog Techniques for the Detection of Coronary Atherosclerosis: Multi-detector Row CT Coronary Angiography Radiology, April 1, 2002; 223(1): 212 - 220. [Abstract] [Full Text] [PDF]
|
|