Coronary calcification in patients with marker-positive acute coronary syndrome

Abstract

The value of assessing coronary artery calcium (CAC) with regard to characterizing unstable coronary artery disease remains controversial. To evaluate the amount of CAC in patients with an acute marker-positive coronary syndrome in segments containing the culprit lesion compared with the remote coronary segments. Thirty-two patients with a marker-positive acute coronary syndrome were examined using electron-beam computed tomography (EBCT), selective coronary angiography and, in some, intravascular ultrasound. The coronary anatomy was analyzed according to the segmental classification proposed by the American Heart Association (AHA). The total EBCT coronary artery calcium score (CAC, Agatston method) was 251±371 (range 0-1629). In 81% of the patients, a greater CAC score was observed than expected on the basis of age and gender. In 30 patients, significant stenoses were detected. The CAC score of the culprit vessel was 108±163 vs 78±134 in the non-culprit vessels and did not differ significantly (P=0.4). The mean CAC score of the coronary segment (AHA classification) containing the culprit lesion was 51±82 vs 29±45 in the other coronary artery segments (P=0.14). Of the two patients with no CAC detected by EBCT, one had no coronary atherosclerosis (confirmed by intravascular ultrasound) and one had one vessel coronary artery disease. Coronary calcium related to the culprit lesion in patients with a marker-positive acute coronary syndrome showed a tendency for an increased amount but was not statistically different from the amount of coronary calcium in remote vessel segments.