Coronary Artery Calcium: Where Do We Stand After Over 3 Decades?

Grundy, Scott M.; Stone, Neil J.

doi:10.1016/j.amjmed.2021.03.043

Cited by 4 publications

(3 citation statements)

References 40 publications

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“…2,3 While the pooled cohort equation remains the cornerstone to estimate ASCVD risk, it can overestimate or underestimate risk in some sub- populations. 23 Hence, it is reasonable to consider individual risk factors that may refi ne patient risk and subsequently individualize treatment strategy. However, if risk assessment is still uncertain after accounting for risk-enhancing factors in patients with borderline or intermediate risk or if the patient is still reluctant to start treatment, obtaining a CAC score is reasonable (class IIa).…”

Section: ■ Evidencementioning

confidence: 99%

Primary and secondary prevention of atherosclerotic cardiovascular disease: A case-based approach

Hariri

Hammoud

Nissen³

et al. 2022

CCJM

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Estimating the risk of atherosclerotic cardiovascular disease (ASCVD) is a daily challenge for clinicians and is crucial to tailoring preventive medical care and guiding shared decision-making. New imaging modalities and novel biomarkers allow for more accurate assessment of patient risk and minimize the risk of over-or undertreating patients. Major cardiovascular medicine societies have incorporated new diagnostic modalities in their guidelines to aid clinical decision-making for primary and secondary prevention of ASCVD. This review presents commonly encountered cases relevant to estimating and reducing ASCVD risk based on available guidelines and expert opinion.

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Section: ■ Evidencementioning

confidence: 99%

Primary and secondary prevention of atherosclerotic cardiovascular disease: A case-based approach

Hariri

Hammoud

Nissen³

et al. 2022

CCJM

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“…However, it is noteworthy that this relation is controversial, as even though the amount of coronary calcification seems to have predictive value for CV events in various populations, the actual impact of calcification on plaque "stability" remains elusive [14,15]. In clinical terms, the visualized presence of calcium deposits within coronary vessels, quantified by the CAC score, showed a robust correlation with CAD [16][17][18][19]. A CAC score of 0 has been consistently associated with a very low risk of adverse CV events and low mortality, whereas very high CAC scores strongly indicate substantial CV risks and advanced plaque burden, as they are associated with increased risks of all causes of mortality, extensive coronary plaque burden, adverse CV events, and even cancer [20,21].…”

Section: Pathophysiology Of Vascular Calcification Arterial Stiffness and Their Interrelationmentioning

confidence: 99%

Role of Matrix Gla Protein in the Complex Network of Coronary Artery Disease: A Comprehensive Review

Kumrić

Borovac

Kurir

et al. 2021

Life

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Coronary artery disease (CAD) is widely recognized as one of the most important clinical entities. In recent years, a large body of accumulated data suggest that coronary artery calcification, a process highly prevalent in patients with CAD, occurs via well-organized biologic processes, rather than passively, as previously regarded. Matrix Gla protein (MGP), a vitamin K-dependent protein, emerged as an important inhibitor of both intimal and medial vascular calcification. The functionality of MGP hinges on two post-translational modifications: phosphorylation and carboxylation. Depending on the above-noted modifications, various species of MGP may exist in circulation, each with their respective level of functionality. Emerging data suggest that dysfunctional species of MGP, markedly, dephosphorylated-uncarboxylated MGP, might find its application as biomarkers of microvascular health, and assist in clinical decision making with regard to initiation of vitamin K supplementation. Hence, in this review we summarized the current knowledge with respect to the role of MGP in the complex network of vascular calcification with concurrent inferences to CAD. In addition, we discussed the effects of warfarin use on MGP functionality, with concomitant implications to coronary plaque stability.

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“…Despite undeniable improvement in percutaneous treatment of coronary artery disease resulting from the introduction of the second generation of drug-eluting stents, calcified coronary lesions are still a challenge for interventional cardiology. According to the literature, calcified plaque burden is increasing with age and the prevalence of renal insufficiency, hypertension, and diabetes [1]; it is an independent risk factor for future cardiovascular events [2]. Coronary interventions in calcified lesions are inextricably linked with a higher rate of periprocedural complications (including dissections, perforations, impairment of stent delivery, and deployment) and several long-term adverse events (such as stent failure, thrombosis, restenosis, and repeat revascularization) [3].…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of a novel calcified plaque modification technique — Shockwave Intravascular Lithotripsy — in patients with coronary artery disease: Mid-term outcomes

Rola

Furtan

Włodarczak³

et al. 2023

Kardiol Pol

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Background: Coronary interventions in calcified lesions are associated with a higher rate of adverse clinical events. Initial aggressive plaque modification along with post-implantation optimization is pivotal for achieving a favorable outcome of percutaneous coronary intervention (PCI). Recently, the Shockwave C2 Intravascular Lithotripsy (S-IVL) System, a novel acoustic wave-based device designed to modify calcified plaque, has been introduced into clinical practice. Aims:We evaluated the mid-term safety and efficiency of S-IVL in a cohort of 131 consecutive patients with severely calcified coronary lesions. Methods:We retrospectively analyzed a total of 131 consecutive S-IVL PCI procedures. The study had two main inclusion criteria -the presence of a calcified resistant lesion (defined by inadequate non-compliant balloon catheter inflation) or a significantly underexpanded stent (more than 20% of reference diameter). The study had two primary endpoints -successful clinical outcome and safety concerns. Clinical success was defined as effective stent deployment or optimization of a previously underexpanded stent (with less than <20% in-stent residual stenosis). Safety outcomes were defined as periprocedural complications, such as device failure and major adverse cardiac and cerebrovascular events (MACCE). Clinical follow-up was performed at the end of hospitalization and 6 months after the index procedure.Results: In-hospital MACCE was 4.6% with 1.5% target lesion revascularization (TLR) and one case of subacute fatal stent thrombosis. At 6-month follow-up, the MACCE rate was 7.9% with a concomitant TLR rate of 3.8%. Conclusion:Our mid-term data confirm acceptable safety and efficacy of intravascular lithotripsy as a valuable strategy for lesion preparation and stent optimization in a cohort of 131 consecutive patients with severely calcified coronary lesions.

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Coronary Artery Calcium: Where Do We Stand After Over 3 Decades?

Cited by 4 publications

References 40 publications

Primary and secondary prevention of atherosclerotic cardiovascular disease: A case-based approach

Primary and secondary prevention of atherosclerotic cardiovascular disease: A case-based approach

Role of Matrix Gla Protein in the Complex Network of Coronary Artery Disease: A Comprehensive Review

Safety and efficacy of a novel calcified plaque modification technique — Shockwave Intravascular Lithotripsy — in patients with coronary artery disease: Mid-term outcomes

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