Evidence map›Paper›PMID 29703635›Full record

ArticleAtherosclerosis2018

Differences in the association of total versus local coronary artery calcium with acute coronary syndrome and culprit lesions in patients with acute chest pain: The coronary calcium paradox.

Stefan B Puchner, Thomas Mayrhofer, Jakob Park, Michael T Lu, Ting Liu, Pal Maurovich-Horvat, Khristine Ghemigian, Daniel O Bittner, Jerome L Fleg, James E Udelson and 3 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Atherosclerosis, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
3.1field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 30 citations in OpenAlex.

  1. Molecular imaging of atherosclerotic plaque vulnerability: a narrative review.The international journal of cardiovascular imaging · 2026
    Review
  2. Review
  3. Article
  4. Article
  5. Review
  6. Review
  7. Article
  8. Review
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 8 institutions in 5 countries.

Stefan B PuchnerDepartment of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Thomas MayrhoferDepartment of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
Jakob ParkDepartment of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Michael T LuDepartment of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Ting LiuDepartment of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China.
Pal Maurovich-HorvatMTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.
Khristine GhemigianDepartment of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Daniel O BittnerDepartment of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, University Hospital Erlangen, Germany.
Jerome L FlegDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
James E UdelsonDivision of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA.
Quynh A TruongDepartment of Radiology and Division of Cardiology, Weill Cornell Medical College, New York, NY, USA.
Udo HoffmannDepartment of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Maros FerencikDepartment of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA. Electronic address: ferencik@ohsu.edu.
Massachusetts General Hospital · USHarvard University · USCornell University · USMedical University of Vienna · ATNational Heart Lung and Blood Institute · USSemmelweis University · HUTufts Medical Center · USUniversity of Applied Sciences Stralsund · DE

Funding

ROMICAT II - CCC - Lead ApplicationU01HL092040 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2009 to 2013
$4.9M
Rule-Out Myocardial Infarction Using Computed Assisted Tomography-ROMICATII,DCCU01HL092022 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI SCHOENFELD, DAVID ALAN · 2009 to 2012
$1.2M
Cardiovascular Imaging in Ischemic Heart DiseaseK24HL113128 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2012 to 2020
$1.1M
Computed Tomography to Predict Response to Cardiac Resynchronization TherapyK23HL098370 · NHLBI · WEILL MEDICAL COLL OF CORNELL UNIV · PI TRUONG, QUYNH A. · 2010 to 2014
$816k
NHLBI NIH HHS K23 HL098370NHLBI NIH HHS K24 HL113128NHLBI NIH HHS U01 HL092022NHLBI NIH HHS U01 HL092040
6 · The paper itself

Abstract

BACKGROUND AND

aimsTotal coronary artery calcium (CAC) burden is associated with an increased cardiovascular risk, while local CAC may represent stable plaques. We determined differences in relationship of total CAC with acute coronary syndrome (ACS) and local CAC with culprit lesions in patients with suspected ACS.

methodsWe performed computed tomography (CT) for CAC and CT angiography to assess the presence of significant stenosis and high-risk plaque (positive remodeling, low CT attenuation, napkin-ring sign, spotty calcium) in 37 patients with ACS and 223 controls. Total and segmental Agatston scores were measured. Culprit lesions were assessed in subjects with ACS.

resultsPatients (n = 260) with vs. without ACS had higher total CAC score (median 229, 25

conclusionsTotal CAC burden was associated with ACS but segmental CAC was not associated with culprit lesions. Our findings suggest that total but not local CAC is a marker of ACS risk and support the hypothesis that extensive local CAC is a marker of plaque stability.

Indexed as

Computed Tomography AngiographyMultidetector Computed TomographyAcute Coronary SyndromeAgedAngina PectorisCoronary AngiographyCoronary Artery DiseaseCoronary StenosisCoronary VesselsFemaleHumansMaleMiddle AgedPlaque, AtheroscleroticPredictive Value of TestsPrevalenceAcute coronary syndromeCardiac computed tomographyCoronary artery calciumCoronary artery calcium densityCoronary artery calcium scoreCulprit lesionsHigh-risk coronary plaque

Identifiers

PMID29703635
PMCPMC5999579
OpenAlexW2799588972

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.