Coronary calcifications in young patients with first, unheralded myocardial infarction: a risk factor matched analysis by electron beam tomography

Abstract

Objective: To compare the presence and extent of coronary calcifications in young patients with first, unheralded acute myocardial infarction with matched controls without a history of coronary artery disease. Methods: In 102 patients under 60 years of age (19-59 years, mean 41 years; 88% male), electron beam tomography was done 1-14 days after acute myocardial infarction, before any coronary intervention. Coronary calcifications were quantified using the Agatston score. Age related calcium centiles were determined based on the Mayo Clinic "epidemiology of coronary calcification" study, and results were compared with a group of 102 controls without coronary artery disease, matched for sex, age, and risk factors. Results: Calcifications were present in 95.1% of patients with acute myocardial infarction and in 59.1% of controls (p = 0.008). The mean (SD) Agatston score was 529 (901) in the infarct patients versus 119 (213) in the controls (p < 0.001). An Agatston score above the 50th centile was present in 87.2% of infarct patients and 47.0% of controls (p = 0.006), and above the 90th centile in 60.7% of infarct patients and only 5.8% of controls (p = 0.001). Conclusions: In young patients with their first, unheralded acute myocardial infarction, the presence and extent of coronary calcium are significantly greater than in matched controls. E lectron beam tomography is a sensitive tool for detecting and quantifying coronary calcifications.1 The amount of coronary calcium correlates with the amount of coronary atherosclerotic plaque.2-5 Thus the presence and extent of coronary artery calcification has been shown to be associated with an individual's risk for cardiovascular events. [6][7][8][9][10][11][12] In up to 50% of patients who suffer an acute myocardial infarct, this event is the first clinical manifestation of coronary artery disease. 13 Recent studies have shown detectable coronary calcifications in 95% of patients with acute coronary syndromes.14 15 However, in younger individuals, coronary events often occur in the presence of early stages of coronary artery disease, presumably caused by the rupture of lipid-rich coronary plaques, [16][17][18] and coronary calcification may be less prevalent than in older patients with acute myocardial infarction. 19 The value of electron beam tomography in detecting relatively young patients at risk of acute myocardial infarction is therefore less clear and has so far not been investigated.Our aim in this study was to assess the prevalence and the extent of coronary calcification in younger patients with a first, unheralded acute myocardial infarct in comparison with matched controls without a history of coronary artery disease. METHODS Patients and controlsWe recruited 102 patients under 60 years of age with an unheralded, first transmural myocardial infarct established by ST elevation on the ECG and increased serum markers of myocardial damage (creatine kinase, creatine kinase MB isoenzyme, and troponin C). Patients with a previously established diagnosis of coronary ...

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New Noninvasive Modalities in Coronary Angiography: Cardiac Computed Tomography Angiography

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Cardiac Computed Tomography for the Diagnosis of Coronary Artery Atherosclerosis

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