Coronary Artery Calcium Progression: An Important Clinical Measurement?

Abstract

Baseline coronary artery calcification (CAC) accurately identifies coronary atherosclerosis and might improve prediction of future cardiac events. Serial assessment of CAC scores has been proposed for monitoring atherosclerosis progression and for assessing the effectiveness of medical therapies aimed at reducing cardiac risk. However, whether knowledge of progression of CAC scores over time further improves risk prediction is unclear. Several trials relating medical therapies to CAC progression have been performed without any formal guidelines on the definition of CAC progression and how it is best quantified. We conducted a comprehensive review of published reports on CAC progression. Increased CAC progression is associated with many known cardiac risk factors. We found that CAC progression correlates with worsening atherosclerosis and may facilitate prediction of future cardiac events. These findings support the notion that slowing CAC progression with therapeutic interventions might provide prognostic benefit. However, despite promising early data, such interventions (most notably with statin therapy) have not been shown to slow the progression of CAC in any randomized controlled trial to date, outside of post hoc subgroup analyses. Thus, routine quantification of CAC progression cannot currently be recommended in clinical practice. First, standards of how CAC progression should be defined and assessed need to be developed. In addition, there remains a need for further studies analyzing the effect of other cardiac therapies on CAC progression and cardiac outcomes.

Evaluation of the Diamondback 360 Coronary Orbital Atherectomy System for treatingde novo, severely calcified lesions

“…In the literature, calcification scoring via CT is often uniquely described but can usually be found in terms of severity, typically ranging from none or mild to severe or >130 Hu for CT angiography [8][9][10][11][12][13][14][15][16][17][18]. Methods for interpreting the score, however, have not been standardized.…”

Coronary Artery Calcium Progression Is Associated with Cardiovascular Events Among Asymptomatic Individuals: From the North Texas Primary Care Practice-based Research Network (NorTex-PBRN)

“…The relationships presented also suggest the merit of considering certain risk factors themselves as surrogates for coronary plaque burden over time and avoiding the need for (repeat) computed tomography. 3,15,[21][22][23][24] Previous studies of CAC risk factors have focused largely on the incidence rather than the progression of CAC. The studies that do look at progression are scarce and often conflict.…”

Imaging Cardiovascular Calcification

“…It predicts future cardiovascular risk beyond the traditional Framingham risk score alone 29, 30, 31, 32. An elevated CACS may portend an increased risk of cardiovascular events in some patients 33. Specifically, the MESA study (Multi‐Ethnic Study of Atherosclerosis) with 6722 patients followed for an average of 3.8 years showed that those with CACS >300 have a nearly 10‐fold increased risk of coronary event across ethnic groups 34.…”

“…However, there are important limitations of CACS including that it generally only represents ≈20% of total plaque volume, it cannot be used to determine if there is flow‐limiting stenosis, and it does not provide information on plaque morphology or subtype because of its lower resolution and poor tissue contrast 62. CACS CT imaging is also unable to detect calcification accurately at a molecular level33 and does not discriminate between microcalcification and macrocalcification, potential markers of vulnerable and stable atherosclerotic plaques, respectively 63, 64…”