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Spotty calcification has recently been introduced as a marker of plaque vulnerability in patients presenting with acute coronary syndrome undergoing invasive and noninvasive coronary imaging, 1 and it has been suggested to be of predictive value for percent atheroma volume with greater progression. 2 Several pathological and clinical studies applying computed tomography (CT) and intravascular ultrasound (IVUS) demonstrated that spotty calcification is more frequently observed in lesions with plaque rupture compared with stable plaque. 3 , 4 Recently, optical coherence tomography (OCT) has emerged as the premier intracoronary imaging technology with a higher resolution (10–20 μm) than IVUS (100–200 μm) and also when compared with noninvasive CT and magnetic resonance imaging, both with a lower resolution (1 mm; Table ). Indeed, OCT studies provided insights into coronary plaque morphology by the ability to discriminate macrophages, fibrous cap thickness, necrotic core/lipid pool, and calcium. 5 However, not all agree that spotty calcification is a marker of plaque vulnerability, because high coronary artery calcium scores (>100 Agatston score) represent a powerful marker of future coronary events. 6 , 7 It is therefore important to distinguish the positive association of overall coronary calcium score with cardiovascular mortality 8 in the general
Circulation: Cardiovascular Imaging – Wolters Kluwer Health
Published: Jan 1, 2016
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