title: Coronary artery calcification score is an independent predictor of the no-reflow phenomenon after reperfusion therapy in acute myocardial infarction.
abstract: OBJECTIVE
  Abundant evidence shows that coronary artery calcification (CAC) is a strong marker of structural and functional changes within the artery wall. Thus far, the implications of CAC in patients with acute coronary syndromes remain unclear. We aimed to investigate whether the CAC score is associated with impaired reperfusion during the acute phase of ST-elevation myocardial infarction (STEMI).
  
  
  METHODS
  We enrolled 60 consecutive STEMI patients to undergo cardiac computed tomography for assessment of the CAC score within 1 week after STEMI. Coronary thrombus burden, coronary blood flow (TIMI flow), and myocardial blush grade (MBG) were evaluated systematically. Patients with maximal TIMI flow and MBG were grouped as optimal reperfusion (n=27) and their counterparts as no-reflow (NR, n=33).
  
  
  RESULTS
  There were no differences in the clinical characteristics between groups. Patients in the NR group had higher heart rate, coronary angiographic severity, and CAC score. CAC score greater than 100 was associated independently with the presence of NR (odds ratio 4.4, 95% confidence interval 1.17-16.3). The CAC score of nonculprit coronary arteries was higher in NR individuals than in their counterparts (P=0.04). In addition, the CAC score of the isnfarct-related artery correlated negatively with the TIMI-flow rate (r=-0.54, P<0.001) and with the MBG (r=-0.32, P=0.04).
  
  
  CONCLUSIONS
  The CAC score is associated with the presence of the NR phenomenon in STEMI patients.
authors.affiliation: aDepartment of Internal Medicine, Cardiology Division, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas bDepartment of Interventional Cardiology, Heart Institute (INCOR), University of São Paulo, São Paulo cEscola Superior de Ciências da Saúde, Brasília, Brazil dJohns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Modolo
authors.forename: Valeria N
authors.initials: VN
authors.lastname: Figueiredo
authors.forename: Filipe A
authors.initials: FA
authors.lastname: Moura
authors.forename: Breno
authors.initials: B
authors.lastname: Almeida
authors.forename: José C
authors.initials: JC
authors.lastname: Quinaglia e Silva
authors.forename: Wilson
authors.initials: W
authors.lastname: Nadruz
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.forename: Otavio R
authors.initials: OR
authors.lastname: Coelho
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.forename: Andrei C
authors.initials: AC
authors.lastname: Sposito
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000453:epidemiology*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000453:epidemiology