RESUMEN
Abstract The coronary artery calcium score plays an Important role In cardiovascular risk stratification, showing a significant association with the medium- or long-term occurrence of major cardiovascular events. Here, we discuss the following: protocols for the acquisition and quantification of the coronary artery calcium score by multidetector computed tomography; the role of the coronary artery calcium score in coronary risk stratification and its comparison with other clinical scores; its indications, interpretation, and prognosis in asymptomatic patients; and its use in patients who are symptomatic or have diabetes.
Resumo O escore de cálcio coronariano tem papel relevante na estratificação de risco cardiovascular, apresentando significativa associação com a ocorrência de eventos cardiovasculares maiores no acompanhamento de médio e longo prazo. São discutidos: os protocolos de aquisição e quantificação por meio da tomografia computadorizada multidetectores; seu papel na estratificação de risco coronariano e relação com os demais escores clínicos; suas indicações, interpretação e prognóstico em pacientes assintomáticos; sua utilização em pacientes sintomáticos e em diabéticos.
RESUMEN
Objetivo: describir las características clínicas y el pronóstico de los pacientes con infarto sin elevación del segmento ST y arterias coronarias normales. Métodos: estudio de cohorte en pacientes con infarto sin elevación del segmento ST con enfermedad coronaria o arterias coronarias normales (sin enfermedad coronaria), en el que se compararon: forma de presentación, intervenciones y desenlaces a un año. Resultados: cada cohorte estuvo compuesta por 24 pacientes. El grupo de pacientes sin enfermedad coronaria fue más joven (56±10 años vs. 63±10 años, p=0,026) y tuvo mayor cantidad de mujeres (62% vs. 29%, p=0,02). El puntaje de riesgo TIMI fue mayor en el grupo con enfermedad coronaria (3,3 vs. 2,5, p=0,02); sin embargo, no se tradujo en coronariografías más tempranas (sin enfermedad coronaria 19±18 h vs. con enfermedad coronaria 27±21 h, p=0,18). El número de vasos enfermos en los pacientes con enfermedad coronaria fue 1,6 y se implantaron 2,04 stents en promedio; en 75% de los casos éstos fueron no medicados. La estancia hospitalaria fue significativamente mayor en el grupo con enfermedad coronaria (3,5±1,7 vs. 2,3±1,1, p=0,01). Los pacientes sin enfermedad coronaria mostraron mejor fracción de eyección (0,57±0,06 vs. 0,50±0,12) y menor número de defectos segmentarios de contractilidad (8 vs. 15 pacientes, p=0,03). No hubo diferencias en cuanto a mortalidad por causa cardiovascular (con enfermedad coronaria 1 caso, sin enfermedad coronaria 0 casos), necesidad de nueva coronariografía (con enfermedad coronaria 1 caso, sin enfermedad coronaria 0 casos) y rehospitalización por dolor torácico (6 casos en ambos grupos). Conclusiones: la probabilidad de rehospitalización por dolor torácico, necesidad de nueva coronariografía y muerte no difirió entre los pacientes con infarto sin elevación del segmento ST con o sin enfermedad coronaria obstructiva.
Objective: to describe the clinical characteristics and prognosis of patients with acute myocardial infarction without ST-segment elevation and normal coronary arteries. Methods: cohort study in patients with myocardial infarction without ST-segment elevation with coronary disease or with normal coronary arteries (without coronary disease), in which we compared clinical presentation, interventions and outcomes at one year. Results: each cohort consisted of 24 patients. The group of patients without coronary disease was younger (56 ± 10 years vs. 63 ± 10 years, p = 0.026) and had more women (62% vs. 29%, p = 0.02). The TIMI risk score was higher in the group with coronary heart disease (3.3 vs. 2.5, p = 0.02); however, it did not result into earlier coronary angiography (without coronary disease 19 ± 18 hours, vs. with coronary artery disease 27 ± 21 hours, p = 0.18). The number of diseased vessels in patients with coronary artery disease was 1.6 and 2.04 stents were implanted on average; in 75% of cases these were not medicated. Hospital stay was significantly higher in the group with coronary heart disease (3.5 ± 1.7 vs. 2.3 ± 1.1, p = 0.01). Patients without coronary artery disease showed better ejection fraction (0.57 ± 0.06 vs. 0.50 ± 0.12) and lower number of segmental defects of contractility (8 vs. 15 patients, p = 0.03). There were no differences in mortality from cardiovascular causes (1 case with coronary artery disease; without coronary disease 0 cases), need for new coronary angiography (1 patient with coronary artery disease, without coronary disease 0 cases), and rehospitalization due to chest pain (6 cases in both groups). Conclusions: the probability of rehospitalization for chest pain, need for new coronary angiography and death did not differ between patients with infarction without ST-segment elevation with or without obstructive coronary disease.