Coronary artery diseaseComparison of the Relation Between the Calcium Score and Plaque Characteristics in Patients With Acute Coronary Syndrome Versus Patients With Stable Coronary Artery Disease, Assessed by Computed Tomography Angiography and Virtual Histology Intravascular Ultrasound
Section snippets
Methods
The study population consisted of 112 patients without known CAD (defined as previous myocardial infarction, coronary arterial bypass grafting, and percutaneous coronary intervention) who were referred for CTA for noninvasive evaluation of chest pain. Subsequently patients were referred for invasive coronary angiography in combination with VH IVUS based on a patient's clinical presentation and/or imaging results. Patient data were prospectively collected in the departmental cardiology
Results
Overall 112 patients were studied; 53 patients presented with ACS and 59 presented with stable CAD. No differences were observed in the prevalence of risk factors for CAD between the 2 groups (Table 1). In patients with ACS cardiac troponin levels were increased in 11 patients (21%), and in 31 patients (58%) significant CAD was demonstrated on invasive coronary angiography. VH IVUS could be performed in all patients and was obtained in 241 vessels (124 vessels [51%] in ACS and 117 vessels [48%]
Discussion
The main finding of the present study was that clinical presentation (ACS vs stable CAD) has a strong impact on the relation between the CS and coronary plaque characteristics. Although the mean number of plaques was similar between patients with ACS and those with stable CAD, when coronary calcium was absent, the plaque burden on computed tomography angiography was significantly greater in patients with ACS than in patients with stable CAD. Invasive VH IVUS findings paralleled noninvasive
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2017, Hellenic Journal of CardiologyCitation Excerpt :We further showed that patients with stable CAD, compared to those with ACS, had a worse cardiovascular risk profile, as assessed by the greater prevalence of hypertension, hypercholesterolemia, and diabetes, despite the similar extent in coronary atherosclerosis. Differences in cardiovascular risk factors between patients with ACS and those with stable CAD have been previously demonstrated, although this was not a consistent finding in all studies.7,11,17 In addition to previous studies, we also evaluated FRS as a measure of the overall coronary risk that proved to be higher in patients with stable CAD (median values were 20% and 16% for patients with stable CAD and ACS, respectively).
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2015, JACC: Cardiovascular ImagingCitation Excerpt :Three in vivo and 1 in vitro grayscale IVUS study have suggested that the amount of coronary artery calcium correlates with coronary artery plaque burden (17–20) and that plaque burden predicts outcomes (21). More recently, albeit in relatively small numbers of patients, lesion-specific parameters on multidetector imaging such as spotty calcium have been correlated with similar VH and grayscale IVUS findings that are indicative of unstable plaques (22–26). Grayscale IVUS detected more calcium in lesions than in reference segments, in severe stenoses than in mild stenoses, in CTOs than in severe stenoses, in negative remodeling than in positive remodeling in patients with stable angina, and in smaller than in larger vessels (15,17,27–30).
This work was supported by Grant 2007B223 from the Dutch Heart Foundation, The Hague, The Netherlands to Dr. van Velzen; the Dutch Technology Foundation STW, Utrecht, The Netherlands; and Grant 10084 from Applied Science Division I and the Technology Program of the Ministry of Economic Affairs, The Hague, The Netherlands to Dr. de Graaf. Dr. Jukema receives grants from Biotronik, Berlin, Germany; Boston Scientific, Natick; Astra Zeneca, London, United Kingdom; Pfizer, New York; MSD, New Jersey. Dr. Schalij has research grants from Biotronik, Berlin, Germany; Boston Scientific, Natick, Massachusetts; and Medtronic, Minneapolis, Minnesota. Dr. Bax has research grants from Biotronik; BMS Medical Imaging, North Billerica, Massachusetts; Boston Scientific; Edwards Lifesciences, Irvine, California; GE Healthcare, Buckinghamshire, United Kingdom; Medtronic; and St. Jude Medical, St. Paul, Minnesota.