Determinants and correlates of target lesion calcium in coronary artery disease: a clinical, angiographic and intravascular ultrasound study.

Objectives: This report used intravascular ultrasound and quantitative coronary angiography to explore the relation between lesion-associated calcium and risk factors, clinical presentation and angiographic severity of coronary artery stenoses.

Background: Coronary artery calcium is a marker for significant coronary atherosclerosis. Noninvasive procedures are being proposed as screening tests for coronary artery disease. Intravascular ultrasound identification of tissue calcium has been validated in vitro.

Methods: Independent chart review, preintervention intravascular ultrasound imaging and coronary angiography were used to study primary native vessel lesions in 1,442 patients. Target lesions and reference segments were evaluated according to previously published quantitative and qualitative methods. Results are presented as mean value +/- SD.

Results: Overall, 1,043 lesions contained target lesion calcium (72%); the arc of target lesion calcium was 110 +/- 109 degrees. Lesions with an ultrasound plaque burden > 0.75 or an angiographic diameter stenosis > 0.25 had a prevalence of calcium of at least 65%, with a mean arc > 100 degrees. Intermediate lesions had as much target lesion calcium as did angiographically severe lesions. Using multivariate linear regression analysis, patient age, stable (vs. unstable) angina and the intravascular ultrasound lesion site and reference segment plaque burden (but not the angiographic diameter stenosis) were the independent predictors of the arc of target lesion calcium (all p < 0.0001).

Conclusions: Intravascular ultrasound analysis shows that coronary calcification correlates with plaque burden but not with degree of lumen compromise. Thus, the noninvasive detection of coronary calcium is predictive of future cardiac events, presumably because coronary calcification is a marker for overall atherosclerotic plaque burden. Coronary calcium increases with increasing patient age and is less common in unstable lesion subsets.