title: Coronary calcification identifies the vulnerable patient rather than the vulnerable Plaque.
abstract: OBJECTIVE
  Presence of coronary artery calcium (CAC) is associated with a high risk of adverse cardiovascular outcomes. Nevertheless, although CAC is a marker of atherosclerosis it is still uncertain whether CAC is a marker of plaque vulnerability. Therefore, the aim of this study was to verify if calcification identifies a vulnerable patient rather than the vulnerable plaque.
  
  
  METHODS
  A morphologic and morphometric study on 960 coronary segments (CS) of 2 groups of patients was performed: (i) 17 patients who died from AMI (510 CS); (ii) 15 age-matched control patients without cardiac history (CTRL, 450 CS).
  
  
  RESULTS
  Calcification was found in 47% CS of AMI and in 24.5% CS of CTRL. The area of calcification was significantly higher in AMI compared to CTRL (p = 0.001). An inverse correlation was found between the extension of calcification and cap inflammation (r(2) = 0.017; p = 0.003). Multivariate regression analysis demonstrated that the calcification was not correlated with the presence of unstable plaques (p = 0.65). Similarly, the distance of calcification from the lumen did not represent an instability factor (p = 0.68).
  
  
  CONCLUSIONS
  The present study suggests that CAC score evaluation represents a valid method to define the generic risk of acute coronary events in a population, but it is not useful to identify the vulnerable plaque that need to be treated in order to prevent an acute event.
authors.affiliation: Anatomic Pathology, University of Rome Tor Vergata, Italy. alessandro.mauriello@uniroma2.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mauriello
authors.forename: Francesca
authors.initials: F
authors.lastname: Servadei
authors.forename: Giuseppe Biondi
authors.initials: GB
authors.lastname: Zoccai
authors.forename: Erica
authors.initials: E
authors.lastname: Giacobbi
authors.forename: Lucia
authors.initials: L
authors.lastname: Anemona
authors.forename: Elena
authors.initials: E
authors.lastname: Bonanno
authors.forename: Sara
authors.initials: S
authors.lastname: Casella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000401:mortality* / Q000473:pathology*; D003328:Coronary Thrombosis / Q000401:mortality / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000401:mortality* / Q000473:pathology*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D061205:Vascular Calcification / Q000401:mortality* / Q000473:pathology*; D014657:Vasculitis / Q000401:mortality / Q000473:pathology