Coronary calcium: The good, the bad, and the uncertain
Coronary calcium: The good, the bad, and the uncertain
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DOI：
10.1016/s0002-8703(99)70403-5
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发表时间：
1999-05-01
影响因子：
4.8
通讯作者：
Shavelle, RM
中科院分区：
文献类型：
--
作者：
Doherty, TM;Detrano, RC;Shavelle, RM
背景 冠状动脉钙沉积被广泛认为是由矿物质在晚期、复杂的动脉粥样硬化病变上结壳或吸附的被动过程造成的。人们越来越关注这些钙沉积物的无创放射学检测，作为冠状动脉疾病临床评估的诊断和预后辅助手段，特别是使用更新的高分辨率成像技术，例如电子束计算机断层扫描。方法和结果我们回顾了有关冠状动脉钙及其与病理性动脉粥样硬化、血管造影狭窄和临床事件的关系的文献。临床钙检测研究表明，冠状动脉钙与冠状动脉疾病的程度和不良事件的风险之间存在关联。过去这些研究倾向于强化这样一种看法，即钙化沉积物是被动矿化过程的结果，预示着晚期冠状动脉疾病，并预示着未来的冠状动脉事件。结论本文回顾的最新病理、遗传、临床和生化证据表明，冠状动脉钙沉积物是一个复杂的、有组织的和受调节的过程的表现，在许多方面与新骨形成相似，可能不是冠状动脉疾病程度或未来事件风险的可靠指标。这些研究还表明，动脉粥样硬化和钙化沉积可能是不同的病理实体，它们经常一起发生，并且以人们知之甚少的方式相互关联。
Background Coronary calcium deposits have been widely regarded to result From a passive process of encrustation or adsorption of mineral onto advanced, complex atherosclerotic lesions. Increasing interest has Focused on noninvasive radiologic detection of these calcium deposits as a diagnostic and prognostic adjunct to clinical evaluation of coronary artery disease, particularly with the use of newer, high-resolution imaging techniques such as electron beam computed tomography.Methods and Results We reviewed the literature on coronary calcium and its relation to pathologic atherosclerosis, angiographic stenoses, and clinical events. Clinical calcium detection studies have demonstrated an association between coronary calcium and both extent of coronary artery disease and risk of adverse events. These studies have in the past tended to reinforce the perception that calcific deposits result from a passive mineralization process, signify advanced coronary artery disease, and foreshadow future coronary events.Conclusions Recent pathologic, genetic, clinical, and biochemical evidence reviewed in this article suggests that coronary calcium deposits are a manifestation of a complex, organized, and regulated process similar in many respects to new bone formation and may not be a reliable indicator of either the extent of coronary disease or the risk of a future event. These studies also suggest that atherosclerosis and calcific deposits may be distinct pathologic entities that frequently occur together and are related-to each other in ways that are poorly understood.