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EXPEDITED REVIEW

Coronary Artery Calcification and Changes in Atheroma Burden in Response to Established Medical Therapies

Stephen J. Nicholls, MBBS, PhD, FRACP, FACC^_*,,,_*,a, E. Murat Tuzcu, MD, FACC^_*,b, Kathy Wolski, MPH^_*, Ilke Sipahi, MD^_*,c, Paul Schoenhagen, MD^_*,, Timothy Crowe, BS^_*, Samir R. Kapadia, MD, FACC^_*, Stanley L. Hazen, MD, PhD^_*,,,d and Steven E. Nissen, MD, FACC^_*,e

^_* Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Department of Cell Biology, Cleveland Clinic, Cleveland, Ohio
Center for Cardiovascular Diagnostics and Prevention, Cleveland Clinic, Cleveland, Ohio
Division of Radiology, Cleveland Clinic, Cleveland, Ohio.

Manuscript received April 12, 2006; revised manuscript received September 21, 2006, accepted October 16, 2006.

^_* Reprint requests and correspondence: Dr. Stephen J. Nicholls, Department of Cardiovascular Medicine, Cleveland Clinic, Mail Code JJ65, 9500 Euclid Avenue, Cleveland, Ohio 44195. (Email: nichols1{at}ccf.org).

OBJECTIVES: This study sought to determine the relationship between coronary calcification and plaque progression in response to established medical therapies.

BACKGROUND: Coronary calcification correlates with the extent of atherosclerosis and predicts clinical outcome.

METHODS: Atheroma volume was determined in serial intravascular ultrasound pullbacks in matched arterial segments of 776 patients with angiographic coronary artery disease. A calcium grade at baseline was assigned for each image (total 28,876) (0 = no calcium, 1 = calcium with acoustic shadowing <90° and 2 = calcium with shadowing >90°). Patients with a calcium index (average of calcium scores in a pullback) below versus above the median were compared with regard to plaque burden and progression.

RESULTS: Patients with a high calcium index were older (59 vs. 54 years, p < 0.001), more likely to be male (80% vs. 68%, p < 0.001), and more likely to have a history of hypertension (71% vs. 64%, p = 0.03). These patients had a greater percentage atheroma volume (PAV) (45% vs. 34%, p < 0.001), total atheroma volume (TAV) (210 vs. 151 mm³, p < 0.001), and percentage of images with maximal plaque thickness >0.5 mm (93% vs. 72%, p < 0.001). The continuous rate of change in PAV (1.1 ± 0.4% vs. 0.8 ± 0.4%, p = 0.34) and TAV (1.7 ± 2.1% vs. –0.1 ± 2.2%, p = 0.37) was similar in patients with a lower and higher calcium index, respectively. A lower calcium index was associated with a higher rate of patients showing substantial change in atheroma burden (at least 5% change in PAV, 70% vs. 53%, p < 0.001).

CONCLUSIONS: Calcific plaques are more resistant to undergoing changes in size in response to systemic interventions targeting atherosclerotic risk factors.

Abbreviations and Acronyms   EEM = external elastic membrane   IVUS = intravascular ultrasound   PAV = percentage atheroma volume   RI = remodeling index   TAV = total atheroma volume

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