Dealing with calcification in the coronary arteries

Figures & data

Figure 1. This figure is a schematic representation of the calcium morphologies, microcalcifications which is thought to be the beginning of the calcification cascade, spotty calcification, which is associated with high risk of events, large calcification which is thought to be more stable and dense calcification.

Table 1. This table describes the morphology of calcium and its significance.

Calcification morphology	Comment	Reference
Microcalcification	Thought to be beginning of the calcification cascade.	[11]
Spotty calcification	Associated with increased risk in CTA, OCT and IVUS imaging trials.	[12–14]
Large calcification	Associated with plaque stability.	[10]

Figure 2. Suggested algorithm for calcific CAD. The presence of calcium in CAD can display different morphologies with different risk profiles, however, its only presence represents risk, thus, we suggest for nonobstructive CAD to go together with CAC score for better risk management.

Otsuka F, Sakakura K, Yahagi K, et al. Has our understanding of calcification in human coronary atherosclerosis progressed? Arterioscler Thromb Vasc Biol. 2014;34:724–736. InternetAvailable from. DOI:10.1161/ATVBAHA.113.302642.

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Mizukoshi M, Kubo T, Takarada S, et al. Coronary superficial and spotty calcium deposits in culprit coronary lesions of acute coronary syndrome as determined by optical coherence tomography. Am J Cardiol. 2013;112:34–40. InternetAvailable from. DOI:10.1016/j.amjcard.2013.02.048.

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