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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^_*,,,_*, E. Murat Tuzcu, MD, FACC^_*, Kathy Wolski, MPH^_*, Ilke Sipahi, MD^_*, Paul Schoenhagen, MD^_*,, Timothy Crowe, BS^_*, Samir R. Kapadia, MD, FACC^_*, Stanley L. Hazen, MD, PhD^_*,, and Steven E. Nissen, MD, FACC^_*

^_* Cardiovascular Medicine
Cell Biology
Center for Cardiovascular Diagnostics and Prevention
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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