High calcium score in an 83-year-old patient with non-ST elevation acute coronary syndrome and nonobstructive coronary artery disease: a case report
https://doi.org/10.15829/1560-4071-2022-4917
Abstract
Currently, multi-slice computed tomography (MSCT) coronary angiography is a leader in the diagnosis of coronary artery disease in patients with non-ST elevation acute coronary syndrome of low or moderate risk. High coronary calcium score (CCS) obtained by MSCT indicate a high probability of obstructive coronary artery disease. In the presented case of an 83-year-old patient with unstable angina, the CCS was 1394, and hemodynamically significant stenoses were detected. However, according to selective coronary angiography, no hemodynamically significant coronary lesions were found. High CCS suggests poor image quality in MSCT coronary angiography. High CCS is detected in most people over 70 years of age. Obviously, in this patient, a high CCS is mainly determined by age. Most studies on CCS did not include patients over 80 years of age. When deciding whether to perform MSCT coronary angiography, it is necessary to take into account the individual characteristics of a particular patient, which may affect the interpretation of results.
About the Authors
K. V. Kuznetsova
Samara State Medical University; V.P. Polyakov Samara Regional Clinical Cardiology Dispensary
Russian Federation
Competing Interests:
Russian Federation
Samara
Competing Interests:
none
E. M. Sukhinina
V.P. Polyakov Samara Regional Clinical Cardiology Dispensary; RZD-Medicine of Samara
Russian Federation
Competing Interests:
Russian Federation
Samara
Competing Interests:
none
A. S. Benyan
Samara State Medical University; Ministry of Health of the Samara Region
Russian Federation
Competing Interests:
Russian Federation
Samara
Competing Interests:
none
D. V. Duplyakov
Samara State Medical University; V.P. Polyakov Samara Regional Clinical Cardiology Dispensary
Russian Federation
Competing Interests:
Russian Federation
Samara
Competing Interests:
none
References
1. Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42:1289-367. doi:10.1093/eurheartj/ehaa575.
2. SCOT-HEART investigators. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicenter trial. The Lancet. 2015;385(9985):2383-91. doi:10.1016/S0140-6736(15)60291-4.
3. Douglas PS, Hoffmann U, Lee KL, et al. PROspective Multicenter Imaging Study for Evaluation of chest pain: rationale and design of the PROMISE trial. Am Heart J. 2014;167:796-803. doi:10.1016/j.ahj.2014.03.003.
4. Lubbers MM, Dedic A, Kurata A, et al. Round-the-clock performance of coronary CT angiography for suspected acute coronary syndrome: results from the BEACON trial. Eur Radiol. 2018;28:2169-75. doi:10.1007/s00330-017-5082-7.
5. Siontis GC, Mavridis D, Greenwood JP, et al. Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials. BMJ. 2018;360. doi:10.1136/bmj.k504.
6. Agatson AS, Janovitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J. Am. Coll. Cardiol. 1990;15:827-32. doi:10.1016/0735-1097(90)90282-t.
7. Erbel R, Mohlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvemend based on quantification of sublinical coronary atherosclerosis. Heinz Nixdorf recall study. J Am Call Cardiol. 2010;56:1397-406. doi:10.1016/j.jacc.2010.06.030.
8. Nikolaev AE, Shapiev AN, Ramazanova DM, et al. New approaches for assessing coronary changes in multi-layer spiral computed tomography. Russian Journal of Cardiology. 2019;(12):124-30. (In Russ.) doi:10.15829/1560-4071-2019-12-124-130.
9. Holick MF, Krane SM, Pott JT: Calcium, phosphorus and bone metabolism: calciumregulating hormones. Harrison’s Principles of Internal Medicine. 14th Edition. Fauci AS, Braunwald E, Isselbacher KJ, et al. (ed): McGraw-Hill, NewYork, NY; 1998. 2214.
10. Zhuravlev KN, Vasilieva EYu, Sinitsyn VE, Spector AV. Calcium score as a screening method for cardiovascular disease diagnosis. Russian Journal of Cardiology. 2019;(12):153-61. (In Russ.) doi:10.15829/1560-4071-2019-12-153-161.
11. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. NEngl J Med. 2008;358,13:1336-45. doi:10.1056/NEJMoa072100.
12. Barbarash OL, Kashtalap VV, Shibanova IA, Kokov AN. Fundamental and practical aspects of coronary artery calcification. Russian Journal of Cardiology. 2020;25(S3):4005. (In Russ.) doi:10.15829/1560- 4071-2020-4005.
13. Mayorov GB, Kurbanov SK, Vlasova EE, et al. Сalcification in coronary heart disease: issues of diagnosis, prognosis and choice of treatment. Russian Cardiology Bulletin. 2018;4:4-10. (In Russ.) doi:10.17116/Cardiobulletin2018130414.
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For citations:
Kuznetsova K.V., Sukhinina E.M., Benyan A.S., Duplyakov D.V. High calcium score in an 83-year-old patient with non-ST elevation acute coronary syndrome and nonobstructive coronary artery disease: a case report. Russian Journal of Cardiology. 2022;27(3S):4917. (In Russ.) https://doi.org/10.15829/1560-4071-2022-4917
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