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The Relationship Between Coronary Calcification and the Natural History of Coronary Artery Disease

Authors
 Han-Young Jin  ;  Jonathan R Weir-McCall  ;  Jonathon A Leipsic  ;  Jang-Won Son  ;  Stephanie L Sellers  ;  Michael Shao  ;  Philipp Blanke  ;  Amir Ahmadi  ;  Martin Hadamitzky  ;  Yong-Jin Kim  ;  Edoardo Conte  ;  Daniele Andreini  ;  Gianluca Pontone  ;  Matthew J Budoff  ;  Ilan Gottlieb  ;  Byoung Kwon Lee  ;  Eun Ju Chun  ;  Filippo Cademartiri  ;  Erica Maffei  ;  Hugo Marques  ;  Pedio de Araujo Goncalves  ;  Sanghoon Shin  ;  Jung Hyun Choi  ;  Renu Virmani  ;  Habib Samady  ;  Peter H Stone  ;  Daniel S Berman  ;  Jagat Narula  ;  Leslee J Shaw  ;  Jeroen J Bax  ;  Kavitha Chinnaiyan  ;  Gilbert Raff  ;  Mouaz H Al-Mallah  ;  Fay Y Lin  ;  James K Min  ;  Ji Min Sung  ;  Sang-Eun Lee  ;  Hyuk-Jae Chang 
Citation
 JACC-CARDIOVASCULAR IMAGING, Vol.14(1) : 233-242, 2021-11 
Journal Title
JACC-CARDIOVASCULAR IMAGING
ISSN
 1936-878X 
Issue Date
2021-11
Keywords
atherosclerosis ; coronary artery calcium ; coronary artery disease ; coronary computed tomography angiography ; statins
Abstract
Objectives: The aim of the current study was to explore the impact of plaque calcification in terms of absolute calcified plaque volume (CPV) and in the context of its percentage of the total plaque volume at a lesion and patient level on the progression of coronary artery disease.

Background: Coronary artery calcification is an established marker of risk of future cardiovascular events. Despite this, plaque calcification is also considered a marker of plaque stability, and it increases in response to medical therapy.

Methods: This analysis included 925 patients with 2,568 lesions from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry, in which patients underwent clinically indicated serial coronary computed tomography angiography. Plaque calcification was examined by using CPV and percent CPV (PCPV), calculated as (CPV/plaque volume) × 100 at a per-plaque and per-patient level (summation of all individual plaques).

Results: CPV was strongly correlated with plaque volume (r = 0.780; p < 0.001) at baseline and with plaque progression (r = 0.297; p < 0.001); however, this association was reversed after accounting for plaque volume at baseline (r = -0.146; p < 0.001). In contrast, PCPV was an independent predictor of a reduction in plaque volume (r = -0.11; p < 0.001) in univariable and multivariable linear regression analyses. Patient-level analysis showed that high CPV was associated with incident major adverse cardiac events (hazard ratio: 3.01: 95% confidence interval: 1.58 to 5.72), whereas high PCPV was inversely associated with major adverse cardiac events (hazard ratio: 0.529; 95% confidence interval: 0.229 to 0.968) in multivariable analysis.

Conclusions: Calcified plaque is a marker for risk of adverse events and disease progression due to its strong association with the total plaque burden. When considered as a percentage of the total plaque volume, increasing PCPV is a marker of plaque stability and reduced risk at both a lesion and patient level. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).
Full Text
https://www.sciencedirect.com/science/article/abs/pii/S1936878X20308883
DOI
10.1016/j.jcmg.2020.08.036
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/186739
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