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We previously reported that different coronary calcification patterns were associated with different pathological and clinical features (JACC, 2014, 63:2220-2233; Eur Heart J, 2012, 33: 372-383). However, the exact mechanisms underlying the association between calcification patterns and acute coronary event risks remain elusive.
Coronary calcification was assessed in vivo (62 cardiac arrest survivors with documented coronary artery disease and 30 patients with a normal coronary angiogram) and ex vivo [52 autopsied sudden cardiac death (SCD) victims and 30 non-SCD patients] using IVUS and OCT. 3D-OCT coronary reconstruction was performed for precisely showing the number and distribution of calcification (Figure).
In in vivo study, spotty calcification was the main calcification pattern within culprit plaques in cardiac arrest survivors. Spotty calcification in cardiac arrest survivors was mostly in superficial location, which vs. that of deep location was associated with more positive remodeling, TCFA, and plaque rupture. Spotty calcium in superficial (but not deep) location correlated negatively with lipid core arc, and positively with cap thickness on OCT. In ex vivo study, patients died of SCD had more spotty calcification and more superficial spotty calcification compared with those who died of non-SCD causes.Pathological analyses showed that spotty calcium, when in superficial location, correlated with greater inflammatory burden and decreased collagen synthesis within human coronary plaques. Moreover, spotty calcium in superficial vs. deep location was associated with more TCFA and plaque rupture.
Spotty calcification in superficial, but not deep, location is a marker of vulnerable plaque in cardiac arrest survivors and autopsied SCD victims.