Postmortem coronary artery calcium score in cases of myocardial infarction

Abstract

Sudden cardiac death (SCD) related to atherosclerotic coronary artery disease (ACAD) resulting in myocardial infarction is the most prevalent cause of death in western countries. In clinical practice, coronary artery calcium score (CACS) is considered an independent predictor of coronary events, closely related to atherosclerotic burden and is quantified radiologically by the Agatston score being calculated through computed tomography. Postmortem computed tomography (PMCT) allows the visualization and quantification of coronary calcifications before the autopsy. However, it was reported that some patients who died from severe ACAD had a zero CACS in PMCT. In this study, a retrospective evaluation of CACS in adult’s myocardial infarction cases related to ACAD, with available CACS and histological slides of coronary arteries, was performed in order to gain a deeper understanding of coronary calcifications and their role in myocardial infarction cases. The CACS was calculated by using the software Smartscore 4.0 after the radiological examination on a 64-row CT unit using a specific cardiac protocol. Thirty-six cases were identified out of 582 autopsies, recorded during a 2-year study period (29 men, 7 women; age 56.3 ± 11.7). CACS was 0–10 in 5 cases (5 men, 44.8 ± 13.7), 11–100 in 8 cases (6 men, 2 women, 53.1 ± 7.7), 101–400 in 13 cases (11 men, 2 women, 57.4 ± 9.6), and > 400 in 10 cases (9 men, 1 woman, 63.1 ± 11.9). Coronary thrombosis was found in 28 cases, histologically identified as plaque erosions in 6 cases and as plaque ruptures in 22 cases. Statistical analyses showed that CACS increases significantly with age (p-value < 0.05) and does not show significant correlation with gender, body weight, body mass index, and heart weight. CACS was significantly higher in plaque ruptures than in plaque erosions (p-value < 0.01). Zero or low CACS on unenhanced PMCT cannot exclude the presence of myocardial infarction related to ACAD. This paradoxical discrepancy between imaging and autopsy findings can be explained considering the histological aspect of fatal coronary plaques.

Is there an association between coronary artery inflammation and coronary atherosclerotic burden?

“…The CAC score is a valid surrogate for the burden of coronary atherosclerosis, and its presence and magnitude are related to the increased risk of cardiovascular events; whereas, patients with a CAC score of 0 have always been considered to have a lower cardiovascular risk in the future ( 12 , 18 ). However, CAD patients with NCP were overlooked by the concept of a CAC score of 0 which could be caught by the CCTA but proven to be dangerous by research ( 19 - 21 ). We, therefore, further subdivided patients with CAC score of 0 into patients with no CAD with CAC score =0 and CAD patients with CAC score =0 to better explore the potential association between PCTA attenuation and CAC score.…”

Characterization of global research trends and prospects on sudden coronary death: A literature visualization analysis

“…ML may become a valuable tool for SCD risk prediction due to its capacity to find patterns that are difficult for humans to identify [ [85] , [86] , [87] ]. Radiological technology based on coronary artery calcification can also be a clue for the diagnosis of sudden coronary death [ 88 , 89 ]. Jaber WA et al [ 90 ] encouraged positron emission tomography with computed tomography assessment in CAA to reduce the occurrence of sudden death.…”

Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases–current achievements and limitations from a pathology perspective

“…This paradoxical discrepancy between imaging and autopsy findings can be explained by considering the histological aspect of fatal coronary plaques in such instances, which are usually highly stenosing eroded lesions composed of fibrocellular but not calcified tissue adjacent to the luminal thrombus. These lesions occur more often at a younger age [ 40 , 41 ]. These results suggest that CACS graded “zero or low” cannot rule out the presence of extensive stenosis and that CACS can neither confirm nor exclude death due to acute coronary artery disease (ACAD).…”