SHAPE Society

1. MI or SCD in Patients with VeryMI or SCD in Patients with Very
Abnormal Cardiac Test ResultsAbnormal Cardiac Test Results
25%
12.3%
Circ 1998;97:535-43
7.1%
JACC 2001;37:1551-7
17%
Cancer Database
0
5
10
15
20
25
30
EBT
Score
>1,000
Severe
SPECT
Abn.
MWMA
Stress
Echo
Lung
Cancer
Mortality
AnnualEventRate(%)
* Asymptomatic Subjects, No Intervention, 36 m. f/u, n=104
* Wayhs JACC 2002;39:225-30
**
** Known Lung Cancer

2. 25 %
50 %
75 %
90 %
Patient's Score
Coronary Calcium Scores in Asymptomatic Women
1
10
100
1000
10000
35 40 45 50 55 60 65 70 75 80
Age
CoronaryCalciumScore
Coronary Calcium Scores in Asymptomatic Men
1
10
100
1000
10000
35 40 45 50 55 60 65 70 75 80
Age
Electron Beam CT – Patient Database
Hoff et al, Am J Cardiol 2001;87:1335-1339 EBT Database n=32,246

3. Prediction of MI/SCD in Asymptomatic Patients:Prediction of MI/SCD in Asymptomatic Patients:
EBTEBT
Raggi et al AHJ 2001;141:193-199Raggi et al AHJ 2001;141:193-199
0.36 0.51 0.71
0.99
1.38
1.92
2.64
3.62
4.9
6.54
0
1
2
3
4
5
6
7
0 10 20 30 40 50 60 70 80 90
Percentile Rank for Baseline EBCT Calcium Score
676 initially asymptomatic patients676 initially asymptomatic patients
3232++7 months f/u7 months f/u
AnnualAnnual AbsoluteAbsolute RiskRisk

4. 15
1.25
1.6
1.6
1.8
2.15
2.35
2.5
5
Lp(a)
Homocysteine
TC
Fibrinogen
t-PA Ag
TC/HDL
hs-CRP
hs-CRP + TC/HDL
EBT Score > 75th
RR in men from the
Physicians Health Study
- values in the upper quartile
Meta-analysis of 6 EBT Studies
Risk of MI in Apparently Healthy PeopleRisk of MI in Apparently Healthy People

5. 96%
16%
25%
8%
29%
8%
39%
0%
0
20
40
60
80
100
Obst.
Disease
1-Vessel 2-Vessel 3-Vessel
SCD (n=28)
Control (n=18)
Schmermund et alSchmermund et al
AtherosclerosisAtherosclerosis 2001 Apr;155(2):499-5082001 Apr;155(2):499-508
%ofIncidence
Obst. Disease: >75% area stenosis
SCD in Patients Under the Age of 50
MOST acute
coronary syndromes
occur in patients
with extensive
pre-existing
CAD

6. EBT and Vulnerable Plaque:EBT and Vulnerable Plaque:
Stary ClassificationStary Classification
I Isolated macrophage foam cells
II Mainly intracellular lipid accumulation, “Fatty Streak”
III Extra-cellular lipid pools, intra- and extra-cellular calcium
IV Core of extra-cellular lipids, “Atheroma”
V Lipid core covered by fibrous cap
Fibroatheroma (Va)/Mainly calcific (Vb)/Mainly fibrotic (Vc)
VI Surface defect (VIa)/Hematoma-hemorrhage (VIb)/Thrombus (VIc)
“regression”
possible
potentially
“vulnerable”

7. Clinical data confirm that coronary calcium by EBT
is found in 96% of those patients either presenting
or, in future, developing acute coronary syndromes
- AND that the amount of CAC was significantly
greater at baseline in such individuals compared
with asymptomatic age and gender matched
persons
Histologic Plaque CharacteristicsHistologic Plaque Characteristics
and Coronary Artery Calciumand Coronary Artery Calcium

8. Histologic Plaque CharacteristicsHistologic Plaque Characteristics
and Coronary Artery Calciumand Coronary Artery Calcium
77
43
54
0
10
20
30
40
50
60
70
80
Acute
Rupture
Erosion Stable
Frequency(%)Frequency(%)
Histologic plaque characterizationHistologic plaque characterization
Stary, Circ 1995;92:1355-1374Stary, Circ 1995;92:1355-1374
Davies, NEJM 1984;310:1137-1140Davies, NEJM 1984;310:1137-1140
Corrado, Circ 1994;90:2315-2323Corrado, Circ 1994;90:2315-2323
after Schmermund et alafter Schmermund et al
Circulation [10/01]Circulation [10/01]
0 %
20 %
Extent
(relativetototalplaquearea)

9. Histologic Plaque CharacteristicsHistologic Plaque Characteristics
and Coronary Artery Calciumand Coronary Artery Calcium
Thus, because there exists considerable
overlap between all types of plaques,
calcium is a marker for neither
stable nor unstable plaque

10. Histologic Plaque CharacteristicsHistologic Plaque Characteristics
and Coronary Artery Calciumand Coronary Artery Calcium
Thus, because there exists considerable
overlap between all types of plaques,
calcium is a marker for neither
stable nor unstable plaque