Spotty Calcification as a Marker of Accelerated Progression of Coronary Atherosclerosis : Insights from Serial Intravascular Ultrasound
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1 Spotty Calcification as a Marker of Accelerated Progression of Coronary Atherosclerosis : Insights from Serial Intravascular Ultrasound Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Yu Kataoka, Kathy Wolski, Kiyoko Uno E. Murat Tuzcu, Steven E Nissen and Stephen J Nicholls ESC 2011 in Paris
2 Presenter Disclosure Information Yu Kataoka, MD Spotty Calcification as a Marker of Accelerated Progression of Coronary Atherosclerosis : Insights from Serial Intravascular Ultrasound FINANCIAL DISCLOSURE: None UNLABELED/UNAPPROVED USES DISCLOSURE: None
3 Nature of Calcified Atheroma Calcified atheroma has been considered as advanced and queiscent atherosclerotic stage. Serial intravascular ultrasound (IVUS) imaging demonstrated that calcified atheroma had more extensive disease which were resistant to undergoing changes in response to medical therapies.
4 Spotty Calcification A small amount of, spotty calcification is one of characteristics in vulnerable lesion and associated with plaque rupture and subsequent ischemic events. However, it remains to be elucidated about the natural history and response to medical therapies in patients with spotty calcification.
5 Objective To determine the atheroma progression in patients with spotty calcification in response to anti-atherosclerotic medical therapies
6 Study Population From 7 clinical trials which monitored atheroma progression by using IVUS, 1347 patients with/without spotty calcification were analyzed. Clinical characteristics and atheroma progression were compared between patients with spotty calcification (n=922) and without spotty calcification (n=425).
7 Definition of Spotty Calcification Spotty calcification was defined as 1-4 consecutive images containing with an arc < 90 entire through imaging segment. spotty calcification spotty calcification spotty calcification
8 IVUS measurements External Elastic Membrane (EEM) area Lumen area Percent Atheroma Volume (PAV) % = [Σ (EEM CSA - Lumen CSA ) / Σ EEM CSA ] 100 CSA = cross sectional area
9 Baseline Characteristics No (n=425) Spotty (n=922) p-value age (years) female (%) <0.001 BMI (kg/m 2 ) hypertension (%) diabetes (%) hyperlipidemia (%) smoker (%) previous myocardial infarction (%)
10 Use of Established Medical Therapies Concomitant Therapy No (n=425) Spotty (n=922) p-value Statins (%) Beta-blocker (%) ACE inhibitor (%) Calcium-channel blocker (%) Aspirin (%)
11 Lipid Profile Control LDL-C (mg/dl) HDL-C (mg/dl) total cholesterol (mg/dl) baseline follow-up absolute change baseline follow-up absolute change baseline follow-up absolute change No (n=425) p-value < Spotty (n=922)
12 Blood Pressure and CRP Control Systolic BP (mmhg) Diastolic BP (mmhg) hscrp (mg/dl) baseline follow-up absolute change baseline follow-up absolute change baseline follow-up absolute change No (n=425) Spotty (n=922) p-value
13 Serial Change in Atheroma Burden No (n=425) Spotty (n=922) p-value baseline PAV 29.0 ± ± 7.5 <0.001 Mean ± SD (mm 3 ) change in PAV 0.02 ± ± Least-square mean ± SE (%) Adjusted for baseline atheroma volume PAV = percent atheroma volume
14 percent Intensive LDL-C Lowering Therapy in Patients with Spotty Calcification change in PAV P<0.001 for trend Least-square mean no spotty no spotty LDL-C < 70mg/dL LDL-C 70mg/dL
15 percent Intensive Systolic BP, CRP Lowering Therapy in Patients with Spotty Calcification percent change in PAV Least-square mean P=0.008 for trend P<0.001 for trend no spotty no spotty no spotty no spotty Systolic BP < 130 mmhg Systolic BP 130 mmhg CRP < 2.0mg/dl CRP 2.0mg/dl
16 Summary Spotty calcification was associated with extensive atheroma burden and greater atheroma progression. Although intensive risk control was effective to slow atheroma progression, this efficacy was attenuated in patients with spotty calcification.
17 Conclusions Patients with spotty calcification harbored extensive and progressive atherosclerotic forms despite intensive medical therapies. These findings underscore more intensive global risk control for the prevention of plaque progression in patients with spotty calcification.
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