Vascular calcification—pathologicaldeposition of hydroxyapatite crystals—can occur throughout the vascular system,including large arteries such as the aorta, carotids, and tibial arteries, aswell as in smaller vessels such as coronary arteries and skin capillaries. Coronaryartery calcification (CAC), as an important manifestation of subclinicalatherosclerosis, is associated with the future cardiovascular disease outcomesand can be used for informing the treatment decision-making for preventivetherapies. Non-coronaryvascular calcifications including the thoracic aortic calcification (TAC) and aorticvalve calcification (AVC) are also associated with the increased risk foradverse cardiovascular events and mortality. However,the value of prediction and risk reclassification by cumulative calcificationscore of CAC, TAC, and AVC in acute ST segment elevation myocardial infarction(STEMI) patients remains unclear.In this study, we calculated the cumulativecalcification scores of CAC, TAC, and AVC, and explored the predictive value ofthe scores for long-term prognosis in acute STEMI patients.

This was a retrospective, single-center cohortstudy. Atotal of 332 STEMI patients who received primarypercutaneous coronary intervention (PPCI) were enrolled in thisstudy between January 2010 to October 2018. We assessed the calcification in the leftanterior descending branch (LAD), left circumflex branch (LCX), right coronaryartery (RCA), thoracic aorta, and aortic valve. Calcification of each part wascounted as 1 point, and the cumulativecalcification score was calculated as the sum of all points. The primary endpoint was all-cause mortality.Multivariate Cox proportional hazards models were used to determine associationof cumulative calcification score withend points. The performance of the score was evaluated by receiver operatingcharacteristic (ROC) curve analysis and compared with the Global Registry ofAcute Coronary Events (GRACE) risk score. For CAC, the calcifications inleft anterior descending branch (LAD), left circumflex branch (LCX), and rightcoronary artery (RCA) were evaluated using coronary angiography. The definitionof calcification was radiopaque densities involving one or two sides of thevascular wall. TAC was assessed based on the presence of visiblecalcification in thoracic aortic on chest X-rays (DXR-Revolution: CarestreamHealth, Rochester, NY, USA) . AVC was evaluated by echocardiography whichwas conducted and analyzed by cardiologists specializing in cardiac imaging.

A total of 332 STEMI patients were enrolled in this study. The characteristics of the study population are listed in Table 1. Themean age was 62.9 years and male patients accounted for 76.2%. Of these STEMIpatients, 60.0%, 52.6%, and 32.3% had hypertension, hypercholesterolemia, anddiabetes mellitus, respectively. At admission, 7.3% of the patients had Killipclassification III–IV and the mean GRACE risk score was 156.9±32.0.According to the calcification score, there were 148 cases in group 1, 111cases in group 2, and 73 cases in group 3. With the score increasing, patientswere older, more often of the female sex, and had more risk factors such ashypertension, diabetes mellitus, and smoking. In the higher calcificationgroup, GRACE risk score, and brain natriuretic peptide (BNP) level were higher .Theoverall population’s calcification score was 2.0±1.6, of which 51.2% had LADartery calcification, 25.3% had LCX calcification, 31.6% had RCA calcification,57.5% had TAC, and 40.7% had ACV. With the increase of calcification score, theproportion of patients with 3 lesions and culprit vessels of the RCA increased. The follow-up results are shown in Table 2. Duringa mean follow-up time of 69.8±29.3 months, the all-cause mortality rate was12.1%. With the increase of calcification fraction, all-cause mortality ingroup 3 was significantly higher compared with group 1 and 2 (p=0.003). Kaplan-Meiercurve showed that the score was significantly associated with mortality(log-rank p<0.001). shows the univariable and multivariableCox proportional hazard analyses adjusted for age and sex for all-cause death.For patients with calcification score 4–5, the unadjusted hazard ratio (HR) was4.18 (95% CI: 1.94–9.00, p=0.001) compared to patients withcalcification score 0–1. The multivariable Cox proportional hazard analysesshowed that calcification score 4–5 was independently associated with all-causedeath in STEMI patients after PPCI (HR =2.51, 95% CI: 1.12–5.61, p=0.025).

In this study, we assessed thecalcification in LAD, LCX, RCA, thoracic aorta, and aortic valve to calculatethe cumulativecalcification scores in a cohort of STEMI patients. Wefound that the calcification score was an independent factor associated with thelong-term prognosis of STEMI patients after PPCI, and it has certain predictivevalue for 3-year mortality.