THE DILEMMA OF DIAGNOSING CORONARY CALCIFICATION - ANGIOGRAPHY VERSUSINTRAVASCULAR ULTRASOUND

Objectives, We sought to determine whether careful examination of angi ograms in conjunction with other clinical information could reliably d etect, quantitate and localize target lesion calcification before a co ronary intervention, Background. The presence, extent and location of calcium in coronary artery lesions are important determinants of outco me after coronary intervention, Intravascular ultrasound is proposed a s a superior technique for identifying patients with coronary artery c alcification, However, the:precise role of-this costly and invasive me thod has not yet been established, Methods. Target lesion calcificatio n was assessed in 183 patients (155 men; mean [+/-SD] age 58 +/- 10 ye ars) by angiography and intravascular ultrasound before a planned perc utaneous coronary intervention, Results. Ultrasound detected calcium i n 138 patients (<90 degrees in 56, 91 degrees to 180 degrees in 52, 18 1 degrees to 270 degrees in 22 and >270 degrees in 8), whereas angiogr aphy showed calcification in 63 (1+ in 32, 2+ in 27 and 3+ in 4), The two techniques agreed in 92 patients and disagreed in 91. Sensitivity and specificity of angiography were 40% and 82%, respectively, The arc of calcium by ultrasound was greater in patients with angiographicall y visible calcification (175 degrees +/- 85 degrees vs, 108 degrees +/ - 71 degrees, p = 0.0001), The depth of calcification by ultrasound wa s superficial in 61 patients (44%), deep in 68 (49%) and mixed in 8 (7 %), The sensitivity of angiography in identifying superficial calcium aas 35%. Of 120 patients without angiographically visible calcium at t he target lesion site, 83 showed calcium by ultrasound, The only predi ctor of ultrasound calcium in these 120 patients was angiographic calc ification elsewhere in the coronary tree (p = 0.0001), The probability of any calcium and superficial >90 degrees calcium were 60% and 12%, respectively, in the 90 patients without angiographic calcifications a nywhere in the coronary tree, Conclusions. Despite poor sensitivity, a ngiography may help identify patients requiring intravascular ultrasou nd, When it is angiographically visible, the are of calcium is likely to be large and superficial, Angiographic calcification at a remote si te is a predictor of angiographically undetected target lesion calcium , Patients without angiographic calcification in the coronary tree may not need routine ultrasound examination, as the likelihood of >90 deg rees superficial calcium is low.