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Invited Commentary
January 22, 2020

The Importance of Coronary Artery Calcium Density

Author Affiliations
  • 1Division of Preventive Medicine, Department of Family Medicine and Public Health and Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, School of Medicine, San Diego
  • 2Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, School of Medicine, San Diego
  • 3US Department of Defense Veterans Affairs Extremity Trauma and Amputation Center of Excellence Naval Health Research Center, San Diego, California
JAMA Cardiol. 2020;5(3):290-291. doi:10.1001/jamacardio.2019.5745

In this issue of JAMA Cardiology,1 an international research group reports results from the Incident Coronary Events Identified by Computed Tomography (ICONIC) Study, a prospective nested case-control study. Patients underwent coronary computed tomography angiography (CCTA) for suspected coronary artery disease (CAD). After a mean follow-up of 3.9 years, 189 patients were identified with acute coronary syndrome (ACS) and propensity-matched to 189 controls who remained ACS free. Importantly, the propensity matching included the qualitative coronary atherosclerotic extent based on CCTA. Overall, cases had less calcified coronary plaque and more fatty, fibrous, and necrotic core plaques. The most striking result was the greater number of high-attenuation plaques in controls, plaques with more than 1000 Hounsfield units that the authors termed 1K plaque.

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